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General NPI Number Information
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NPI Number | 1255689642
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Entity Type | Individual
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Provider Name | BRADFORD DANIEL WITHINGTON NP
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Gender | Male
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 1027 N 9TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53233-1411
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Country | US
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Telephone | 414-765-0606
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Fax | 414-765-0226
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Provider Business Mailing Address
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Address Line | 413 N 2ND ST UNIT 460
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City | MILWAUKEE
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State | WI
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Zip | 53203-3100
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Country | US
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Telephone | 920-254-6266
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4938-33
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License Number State | WI
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