Healthcare Provider Details

I. General information

NPI: 1558513671
Provider Name (Legal Business Name): DEBORAH JEAN FOSTER-BRADLEY RN, BS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 ARIEL ST N
MAPLEWOOD MN
55109-2248
US

IV. Provider business mailing address

2385 ARIEL ST N
MAPLEWOOD MN
55109-2248
US

V. Phone/Fax

Practice location:
  • Phone: 651-789-8764
  • Fax: 651-789-8784
Mailing address:
  • Phone: 651-789-8764
  • Fax: 651-789-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR75486-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: