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General NPI Number Information
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NPI Number | 1407005051
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Entity Type | Individual
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Provider Name | BLUE E BRADLEY CNM, ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 541 W. SECOND AVENUE
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City | TWISP
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State | WA
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Zip | 98856
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Country | US
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Telephone | 509-422-5700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | OKANOGAN
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State | WA
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Zip | 98840-1340
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Country | US
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Telephone | 509-689-2525
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP60035365
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP60035365
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License Number State | WA
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