Individual
HOLLY BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8865 W 400 N STE 120, MICHIGAN CITY, IN 46360-9011
(219) 878-5031
(219) 879-5498
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006753A
IN
363LF0000X
Family Nurse Practitioner
28203078A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201407950
—
IN
Enumeration date
11/03/2016
Last updated
03/22/2023
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