1225009996 NPI number — ESTENA PATRICIA BRADLEY NP- WOMENS HEALTH

Table of content: ESTENA PATRICIA BRADLEY NP- WOMENS HEALTH (NPI 1225009996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225009996 NPI number — ESTENA PATRICIA BRADLEY NP- WOMENS HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADLEY
Provider First Name:
ESTENA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP- WOMENS HEALTH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDERSON
Provider Other First Name:
ESTENA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNCGONP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225009996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27565-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-492-8576
Provider Business Mailing Address Fax Number:
252-492-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 SE INDUSTRY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-492-8576
Provider Business Practice Location Address Fax Number:
252-492-7464
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  79052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500018286 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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