Healthcare Provider Details

I. General information

NPI: 1467796417
Provider Name (Legal Business Name): JULIE ELLEN BRADFORD MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 WESTSHIRE DR STE 100
LANSING MI
48917-9703
US

IV. Provider business mailing address

26908 DETROIT RD STE 301
WESTLAKE OH
44145-2399
US

V. Phone/Fax

Practice location:
  • Phone: 517-622-2788
  • Fax:
Mailing address:
  • Phone: 440-617-1823
  • Fax: 440-617-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704260128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: