MEDICARE: NICOLA BRADLEY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	228276	MA

General Provider Information

NPI Number	:	1164554341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA BRADLEY CRNA

Provider Business Mailing Address
First Line	:	110 GREGORY ISLAND RD
Second Line	:
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 GREGORY ISLAND RD
Second Line	:
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2638
Country	:	US
Telephone Number	:	617-785-2959
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	01/23/2012

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