Healthcare Provider Details

I. General information

NPI: 1083836910
Provider Name (Legal Business Name): MARY LUCILE BRADFORD NNP-BC, MN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE
DENVER CO
80218-1235
US

IV. Provider business mailing address

129 ROWENA PL
LAFAYETTE CO
80026-3134
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7790
  • Fax: 303-839-7987
Mailing address:
  • Phone: 303-673-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number125034
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: