Healthcare Provider Details

I. General information

NPI: 1841871555
Provider Name (Legal Business Name): DANIEL RAMON BRADFORD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD
BURKE VA
22015-2880
US

IV. Provider business mailing address

PO BOX 2788
WOODBRIDGE VA
22195-2788
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001277264
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: