Healthcare Provider Details

I. General information

NPI: 1699886432
Provider Name (Legal Business Name): BARBARA A BRADLEY R.N.C., M.S., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAPLE ST SUITE 201
MARLBOROUGH MA
01752-3200
US

IV. Provider business mailing address

526 MAIN ST 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-9613
  • Fax: 508-460-0922
Mailing address:
  • Phone: 978-849-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number196922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: