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General NPI Number Information
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NPI Number | 1053761924
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Entity Type | Individual
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Provider Name | CALLIE BRADLEY APRN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 10 S 2000 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-5880
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Country | US
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Telephone | 801-581-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 724 S MASON ST
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City | HARRISONBURG
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State | VA
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Zip | 22807-1050
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Country | US
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Telephone | 435-559-4653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8635924-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024186726
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License Number State | VA
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