Individual
BRADLEY G NEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
204 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
(715) 483-3221
Mailing address
204 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
(715) 483-3221
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1436-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165875100
—
MN
01
—
31G80NE
BLUE CROSS FACILITY
MN
05
—
39087700
—
WI
01
—
620006571
RAILROAD MEDICARE
—
01
—
86D52NE
BLUE CROSS PRO FEE
MN
01
—
HP30609
HEALTHPARTNERS
—
01
—
NA9031023578
PREFERREDONE
—
Enumeration date
09/21/2006
Last updated
07/08/2007
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