Individual
MR. BRADLEY ROBERTS
Active
Individual
MR. BRADLEY ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
NUR-RN-LIC-23565
MT
363LA2100X
Acute Care Nurse Practitioner
Primary
NUR-APRN-100295
MT
363LA2100X
Acute Care Nurse Practitioner
RN23565
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000374780
BCBS PIN
MT
01
—
121017300
MDCD PIN
WY
01
—
4305896
MDCD PIN
MT
Enumeration date
06/28/2005
Last updated
03/07/2023
Update your record
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