Healthcare Provider Details

I. General information

NPI: 1518201730
Provider Name (Legal Business Name): VANESSA BRADFORD MAXWELL MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA KRISTINE BRADFORD

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 RUCKER AVE
EVERETT WA
98201-4833
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5421
  • Fax: 425-259-1182
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN60229600
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4181806
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60319977
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: