Individual
ANGELA KATHERINE BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 808-8802
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28177964A
IN
363LF0000X
Family Nurse Practitioner
Primary
71005908A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201333350
—
IN
01
—
71005908A
STATE LICENSE
IN
01
—
P01678731
RR MEDICARE
IN
Enumeration date
09/01/2015
Last updated
05/24/2024
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