MEDICARE: CASSANDRA BRADLEY DBA LAKE LOVELAND ANESTHESIA

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

General Provider Information

NPI Number	:	1447116587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSANDRA BRADLEY DBA LAKE LOVELAND ANESTHESIA

Provider Business Mailing Address
First Line	:	PO BOX 7117
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-0117
Country	:	US
Telephone Number	:	970-290-7403
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 RIVERSIDE AVE STE C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4366
Country	:	US
Telephone Number	:	970-484-4620
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASSANDRA BRADLEY
Credential	:	CRNA
Telephone Number	:	970-290-7403

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/12/2026

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