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General NPI Number Information
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NPI Number | 1184663973
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Entity Type | Individual
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Provider Name | BRADLEY CHRISTOPHER HAGEN ARNP, FNP
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 418 W. MAIN AVENUE
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City | BREWSTER
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State | WA
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Zip | 98812
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Country | US
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Telephone | 509-689-8900
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Fax | 509-689-9031
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Provider Business Mailing Address
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Address Line | 1390 BIDDLE RD STE 101
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City | MEDFORD
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State | OR
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Zip | 97504-4169
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 091006932N1
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License Number State | OR
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