Individual
COREENA J BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
75 YELLOW CREEK RD, STE 105, EVANSTON, WY 82930-5235
(307) 789-4224
(307) 789-4225
Mailing address
75 YELLOW CREEK RD, STE 105, EVANSTON, WY 82930-5235
(307) 789-4224
(307) 789-4225
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
245
WY
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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