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General NPI Number Information
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NPI Number | 1144853466
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Entity Type | Individual
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Provider Name | JANE ELLEN BRADLEY CNM
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Gender | Female
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 606 24TH AVE S STE 700
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1462
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Country | US
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Telephone | 855-324-7843
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Fax |
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Provider Business Mailing Address
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Address Line | 18 IMPERIAL PL UNIT 2D
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City | PROVIDENCE
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State | RI
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Zip | 02903-4642
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Country | US
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Telephone | 563-564-6658
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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