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General NPI Number Information
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NPI Number | 1174437248
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Entity Type | Individual
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Provider Name | ZOE NICOLE BRADSHAW
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Gender |
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 1000 W BELLWOOD LN STE 1
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City | SALT LAKE CITY
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State | UT
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Zip | 84123-4494
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Country | US
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Telephone | 801-880-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 428 E DOWNINGTON AVE APT 4
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2256
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Country | US
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Telephone |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | NULL
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