Individual
V JEAN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7910 W JEFFERSON BLVD, SUITE 300, FORT WAYNE, IN 46804-4159
(260) 432-1800
(260) 432-1804
Mailing address
7910 W JEFFERSON BLVD, SUITE 300, FORT WAYNE, IN 46804-4159
(260) 432-1800
(260) 432-1804
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71001398
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200406350
—
IN
Enumeration date
05/17/2006
Last updated
11/05/2010
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