Individual
LISA CHARISEE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
4135 HOLMAN LN, SAINT LOUIS, MO 63134-3925
(314) 479-6121
(314) 479-6121
Mailing address
4135 HOLMAN LN, SAINT LOUIS, MO 63134-3925
(314) 479-6121
(314) 479-6121
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431921811
—
MO
Enumeration date
03/13/2019
Last updated
03/13/2019
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