Healthcare Provider Details

I. General information

NPI: 1164172144
Provider Name (Legal Business Name): SHAWNA R BRADLEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4530
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4530
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4501
  • Fax:
Mailing address:
  • Phone: 701-712-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR43239
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR43239
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: