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NPI Code Detail

MEDICARE: ANNEMARI BRADIN PPC

MEDICARE: ANNEMARI BRADIN PPC
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
1101Y00000XCounselor609WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1609OTHERWYSTATE LICENSE

General Provider Information

NPI Number : 1134400328
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNEMARI BRADIN PPC
Provider Business Mailing Address
First Line : 918 S 8TH ST
Second Line :
City : LARAMIE
State : WY
Zip : 82070-4532
Country : US
Telephone Number : 307-745-8997
Fax Number :
Provider Business Practice Location Address
First Line : 4989 N 3RD ST
Second Line :
City : LARAMIE
State : WY
Zip : 82072-9548
Country : US
Telephone Number : 307-745-8997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 11/15/2011

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