Healthcare Provider Details

I. General information

NPI: 1275455248
Provider Name (Legal Business Name): BRADLEY CHUKWUNONSO NWOSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 BROADWAY STE 209
LYNN MA
01904-2654
US

IV. Provider business mailing address

328 BROADWAY STE 209
LYNN MA
01904-2654
US

V. Phone/Fax

Practice location:
  • Phone: 781-842-1071
  • Fax: 781-842-0173
Mailing address:
  • Phone:
  • Fax: 781-842-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2299752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: