Individual
BRADLEY ROBERT CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 SUNSET DR, LA GRANDE, OR 97850-1387
(541) 963-8421
(541) 963-1476
Mailing address
PO BOX 3290, LA GRANDE, OR 97850-7290
(541) 963-8421
(541) 963-1476
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024173219
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
201902612CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500763836
—
OR
Enumeration date
02/02/2016
Last updated
03/25/2022
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