Healthcare Provider Details

I. General information

NPI: 1144853466
Provider Name (Legal Business Name): JANE ELLEN BRADLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S STE 700
MINNEAPOLIS MN
55454-1462
US

IV. Provider business mailing address

18 IMPERIAL PL UNIT 2D
PROVIDENCE RI
02903-4642
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone: 563-564-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: