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General NPI Number Information
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NPI Number | 1639269707
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Entity Type | Individual
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Provider Name | CAROLYN A BRADFORD CNM
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 1400 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4422
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Country | US
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Telephone | 209-522-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4422
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Country | US
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Telephone | 209-522-1027
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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 | 3174
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License Number State | CA
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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 | NM639
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License Number State | CA
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