Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5437-33 | WI |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5437 | WI |
NPI | 1023442654 |
---|---|
Provider Name | Bradley Smith |
First Address | Brookfield, WI 53045-6102 |
Second Address | Milwaukee, WI 53210-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 01/08/2019 |