MEDICARE: MS. TERESA A BRADSHAW CRNFA

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	163WN0800X	Neuroscience Registered Nurse	R0036252	OK

General Provider Information

NPI Number	:	1639358708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA A BRADSHAW CRNFA

Provider Business Mailing Address
First Line	:	4120 W MEMORIAL RD
Second Line	:	SUITE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9320
Country	:	US
Telephone Number	:	405-748-3300
Fax Number	:	877-657-5008

Provider Business Practice Location Address
First Line	:	4120 W MEMORIAL RD
Second Line	:	SUITE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9320
Country	:	US
Telephone Number	:	405-748-3300
Fax Number	:	877-657-5008

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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