Provider Demographics
NPI:1871215780
Name:BRADLEY, TERI LOUISE (RN)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LOUISE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 TOWNSHIP ROAD 160
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:OH
Mailing Address - Zip Code:45688-9324
Mailing Address - Country:US
Mailing Address - Phone:606-369-5255
Mailing Address - Fax:
Practice Address - Street 1:5187 US ROUTE 60 STE 13
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2076
Practice Address - Country:US
Practice Address - Phone:304-733-5010
Practice Address - Fax:304-733-5024
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74883163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health