Healthcare Provider Details

I. General information

NPI: 1184663973
Provider Name (Legal Business Name): BRADLEY CHRISTOPHER HAGEN ARNP, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W. MAIN AVENUE
BREWSTER WA
98812
US

IV. Provider business mailing address

1390 BIDDLE RD STE 101
MEDFORD OR
97504-4169
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-8900
  • Fax: 509-689-9031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number091006932N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: