Healthcare Provider Details

I. General information

NPI: 1174808422
Provider Name (Legal Business Name): ANNIE COLLINS COLE-BRADLEY APRN, DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 CHAD DR
EUGENE OR
97408-7428
US

IV. Provider business mailing address

3355 CHAD DR
EUGENE OR
97408-7428
US

V. Phone/Fax

Practice location:
  • Phone: 541-530-5515
  • Fax: 541-607-7467
Mailing address:
  • Phone: 541-530-5515
  • Fax: 541-607-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201910139NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019099997RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: