Healthcare Provider Details

I. General information

NPI: 1528795259
Provider Name (Legal Business Name): JANET M BRADSHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 ENTERPRISE DR
SAGINAW MI
48603-2310
US

IV. Provider business mailing address

3150 ENTERPRISE DR
SAGINAW MI
48603-2310
US

V. Phone/Fax

Practice location:
  • Phone: 989-249-0929
  • Fax: 989-249-1147
Mailing address:
  • Phone: 989-249-0929
  • Fax: 989-249-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704153619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: