Individual
MR. BRADLEY JOHN ESPESETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R60407
NM
363LF0000X
Family Nurse Practitioner
Primary
CNP-03469
NM
Other
Enumeration date
12/12/2007
Last updated
11/06/2018
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