MEDICARE: JOSEPH BRADSHAW REGISTERED NURSE

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	311ZA0620X	Adult Care Home Facility	23Z784	CO

General Provider Information

NPI Number	:	1508331240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BRADSHAW REGISTERED NURSE

Provider Business Mailing Address
First Line	:	2912 S ZENOBIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-2031
Country	:	US
Telephone Number	:	303-356-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5290 W PRINCETON DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-3127
Country	:	US
Telephone Number	:	303-988-5295
Fax Number	:

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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