Individual
MS. COLLEEN ANN BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
456 N NEW BALLAS RD, STE 304, SAINT LOUIS, MO 63141-6831
(314) 567-6868
(314) 567-0578
Mailing address
456 N NEW BALLAS RD, STE 304, SAINT LOUIS, MO 63141-6831
(314) 567-6868
(314) 567-0578
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2017036482
MO
363LP0200X
Pediatric Nurse Practitioner
2017036482
MO
Other
Enumeration date
08/28/2013
Last updated
05/09/2024
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