MEDICARE: MS. LINDA JOY BRADISH LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	110564	OH

General Provider Information

NPI Number	:	1013208388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA JOY BRADISH LPN

Provider Business Mailing Address
First Line	:	PO.BOX 184
Second Line	:	142 S.RICH ST.
City	:	MT. GILEAD
State	:	OH
Zip	:	43338
Country	:	US
Telephone Number	:	740-262-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 S RICH ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1438
Country	:	US
Telephone Number	:	740-262-9540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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