Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP-1317A | ID |
NPI | 1033542634 |
---|---|
Provider Name | Mr. Nathan Eric Bradfield |
First Address | Idaho Falls, ID 83404-7549 |
Second Address | Idaho Falls, ID 83404-7549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 17/10/2016 |