Healthcare Provider Details

I. General information

NPI: 1104454701
Provider Name (Legal Business Name): WHITNEY BRADSHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

35334 TINGLE RD
WILLARDS MD
21874-1323
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7162
  • Fax:
Mailing address:
  • Phone: 443-235-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR209524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: