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NPI Code Detail

MEDICARE: REGINA BRADBURN LSW

MEDICARE: REGINA BRADBURN LSW
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
1104100000XSocial Worker33011798AIN

General Provider Information

NPI Number : 1407745961
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA BRADBURN LSW
Provider Business Mailing Address
First Line : 3301 W PURDUE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6356
Country : US
Telephone Number : 765-284-0043
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W PURDUE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6356
Country : US
Telephone Number : 765-284-0043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2025
Last Update Date : 06/30/2025

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Directions to “ REGINA BRADBURN LSW” Practice Location

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