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General NPI Number Information
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NPI Number | 1962154658
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Entity Type | Individual
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Provider Name | CRISTIN LEANNE BRADLEY AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2041 WILLOW RD
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City | GREENSBORO
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State | NC
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Zip | 27406-3831
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Country | US
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Telephone | 336-272-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 130 CHURCH AVE SW
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City | ROANOKE
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State | VA
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Zip | 24011-1906
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Country | US
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Telephone | 540-769-3964
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AG01220092
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License Number State | NC
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