Healthcare Provider Details

I. General information

NPI: 1700141306
Provider Name (Legal Business Name): BRADLEY STROHM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15875 LONDON RD
ORIENT OH
43146-9728
US

IV. Provider business mailing address

15875 LONDON RD
ORIENT OH
43146-9728
US

V. Phone/Fax

Practice location:
  • Phone: 614-716-9695
  • Fax:
Mailing address:
  • Phone: 614-716-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number227772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: