MEDICARE: ROBYN BRADFORD LPN

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	164W00000X	Licensed Practical Nurse	PN-103668	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790908150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN BRADFORD LPN

Provider Business Mailing Address
First Line	:	PO BOX 167
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-0167
Country	:	US
Telephone Number	:	937-776-6292
Fax Number	:

Provider Business Practice Location Address
First Line	:	4090 LOCUS BEND DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-4069
Country	:	US
Telephone Number	:	937-776-6292
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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