Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95003232 | CA |
NPI | 1063883551 |
---|---|
Provider Name | Lauren Lewis Bradley |
First Address | Porterville, CA 93257-1989 |
Second Address | Madera, CA 93636-8762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2015 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487980538 | (05) | CA |