Healthcare Provider Details

I. General information

NPI: 1730362682
Provider Name (Legal Business Name): RACHELLE SOFIA BRADLEY ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003 BURT ST
OMAHA NE
68132-2207
US

IV. Provider business mailing address

5003 BURT ST
OMAHA NE
68132-2207
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-6714
  • Fax:
Mailing address:
  • Phone: 402-391-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number485
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000399
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: