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General NPI Number Information
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NPI Number | 1629520564
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Entity Type | Individual
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Provider Name | SUSANA C BRADBURY CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2003 MEDICAL PKWY STE 250
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3098
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Country | US
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Telephone | 410-224-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 17224 TEAGUES POINT RD
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City | HUGHESVILLE
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State | MD
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Zip | 20637-2803
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Country | US
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Telephone | 301-274-5860
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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 | R153079
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License Number State | MD
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