1568472124 NPI number — MRS. REBECCA LYNN BRADY CNM RN

Table of content: MRS. REBECCA LYNN BRADY CNM RN (NPI 1568472124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568472124 NPI number — MRS. REBECCA LYNN BRADY CNM RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADY
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIDGETT
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568472124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HONEYSUCKLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-374-8343
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-365-3519
Provider Business Practice Location Address Fax Number:
856-963-2185
Provider Enumeration Date:
08/08/2006

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: 163W00000X , with the licence number:  26NR10137400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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