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General NPI Number Information
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NPI Number | 1669643060
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Entity Type | Individual
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Provider Name | KRISTIN R BRADLEY NP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 2215 44TH ST SW
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City | WYOMING
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State | MI
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Zip | 49519-6439
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Country | US
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Telephone | 616-252-8300
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Fax | 616-252-8460
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Provider Business Mailing Address
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Address Line | 1925 BRETON RD SE SUITE 201
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4810
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Country | US
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Telephone |
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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 | 4704224909
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License Number State | MI
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