Individual
MAYA MIKKIA BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-2031
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-2031
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P63115
IA
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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