Healthcare Provider Details

I. General information

NPI: 1245955368
Provider Name (Legal Business Name): MONIQUE KAY BRADFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE KAY STIGGER NP

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7612 GRATIOT AVE
DETROIT MI
48213-2822
US

IV. Provider business mailing address

28815 ELMWOOD ST
GARDEN CITY MI
48135-2473
US

V. Phone/Fax

Practice location:
  • Phone: 313-548-3787
  • Fax:
Mailing address:
  • Phone: 313-205-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704273304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: