Individual
DONNA ELLEN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160 MP 394.3, KAYENTA, AZ 86033-0368
(928) 697-4100
(928) 697-4029
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1075297
KY
163WE0003X
Emergency Registered Nurse
1075297
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030073
MEDICARE OSCAR/CERTIFICATION
AZ
05
—
060012
—
AZ
01
—
HSZ045
MEDICARE PIN
AZ
Enumeration date
02/10/2020
Last updated
02/10/2020
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