Provider Demographics
NPI:1174160402
Name:BRADLEY, RHENA N
Entity type:Individual
Prefix:
First Name:RHENA
Middle Name:N
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827
Mailing Address - Country:US
Mailing Address - Phone:708-880-1397
Mailing Address - Fax:708-880-1215
Practice Address - Street 1:502 W 138TH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-1611
Practice Address - Country:US
Practice Address - Phone:708-880-1397
Practice Address - Fax:708-880-1215
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide