Healthcare Provider Details

I. General information

NPI: 1619897378
Provider Name (Legal Business Name): AUDREY BRADFISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MONTGOMERY ST
SPARTA WI
54656-1450
US

IV. Provider business mailing address

900 E MONTGOMERY ST
SPARTA WI
54656-1450
US

V. Phone/Fax

Practice location:
  • Phone: 608-633-3687
  • Fax:
Mailing address:
  • Phone: 608-633-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number234817-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: