Healthcare Provider Details

I. General information

NPI: 1083640395
Provider Name (Legal Business Name): SANDRA BRADLEY BADEN F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FOOTHILLS DR
MORGANTON NC
28655-5123
US

IV. Provider business mailing address

111 FOOTHILLS DR
MORGANTON NC
28655-5123
US

V. Phone/Fax

Practice location:
  • Phone: 828-438-4683
  • Fax: 828-438-4608
Mailing address:
  • Phone: 828-438-4683
  • Fax: 828-438-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200234
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: