Healthcare Provider Details

I. General information

NPI: 1306751201
Provider Name (Legal Business Name): ALICE BRADFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HILLSIDE ST
NEWINGTON CT
06111-3709
US

IV. Provider business mailing address

30 HILLSIDE ST
NEWINGTON CT
06111-3709
US

V. Phone/Fax

Practice location:
  • Phone: 360-477-2323
  • Fax:
Mailing address:
  • Phone: 360-477-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17193
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: