Individual
MR. BRADLEY JAMES NUCKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1152 WOOD ST, CALIFORNIA, PA 15419-1260
(724) 938-2099
(724) 938-3221
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440098
—
PA
01
—
328834D024298
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
11/30/2005
Last updated
04/11/2008
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