Basic Information
| Provider Information | |||||||||
| NPI: | 1699886432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | R.N.C., M.S., N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 MAIN ST 302 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788497507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 MAPLE ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MARLBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017523200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084609613 | ||||||||
| FaxNumber: | 5084600922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 196922 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | NP3644 | 01 | MA | BC/BS | OTHER | P00262193 | 01 | MA | MEDICARE RAILROAD | OTHER | 98113 | 01 | MA | FALLEN COMMUNITY HEALTH C | OTHER |