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General NPI Number Information
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NPI Number | 1972501849
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Entity Type | Individual
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Provider Name | BRADLEY A. NACE
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 240 S MAIN ST
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City | WOLFEBORO
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State | NH
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Zip | 03894-4455
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Country | US
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Telephone | 603-569-7690
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Fax | 603-569-7664
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Provider Business Mailing Address
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Address Line | 240 S MAIN ST
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City | WOLFEBORO
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State | NH
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Zip | 03894-4455
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Country | US
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Telephone | 603-569-7690
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Fax | 603-569-7664
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA003465L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0003736
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2149
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-2307
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License Number State | ID
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