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General NPI Number Information
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NPI Number | 1225913965
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Entity Type | Individual
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Provider Name | BRADLEY JAY DILLON
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Gender | Male
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 715 MALL RING CIR STE 202
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City | HENDERSON
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State | NV
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Zip | 89014-6667
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Country | US
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Telephone | 702-483-6200
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Fax | 702-483-6202
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Provider Business Mailing Address
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Address Line | 12732 FEATHERSONG ST
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City | HENDERSON
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State | NV
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Zip | 89044-1074
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Country | US
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Telephone | 402-516-4560
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 823820
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License Number State | NV
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