Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AZ85747 | AZ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | TAP4148 | AZ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP4148 | AZ |
NPI | 1073801650 |
---|---|
Provider Name | Valerie Ann Bradley |
First Address | Tucson, AZ 85719-2995 |
Second Address | Tucson, AZ 85719-2995 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
854428 | (05) | AZ |