Individual
AUDREY ELISE BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1660 BROADWAY STE 165, FORT WAYNE, IN 46802-0011
(260) 266-9805
(260) 266-9815
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10005240A
IN
363A00000X
Physician Assistant
5601013822
MI
Other
Enumeration date
02/10/2026
Last updated
07/10/2026
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