Healthcare Provider Details

I. General information

NPI: 1528448792
Provider Name (Legal Business Name): BRADLEY S. HUGHES LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 N. SAGINAW RD.
MIDLAND MI
48640
US

IV. Provider business mailing address

3007 N. SAGINAW RD.
MIDLAND MI
48640
US

V. Phone/Fax

Practice location:
  • Phone: 989-633-1400
  • Fax:
Mailing address:
  • Phone: 989-633-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4703114523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: