Provider Demographics
NPI:1669064614
Name:HANK, BRADLEE ELIZABETH
Entity type:Individual
Prefix:
First Name:BRADLEE
Middle Name:ELIZABETH
Last Name:HANK
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 1:10008 COUNTY ROAD X61
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-9481
Mailing Address - Country:US
Mailing Address - Phone:563-260-6772
Mailing Address - Fax:
Practice Address - Street 1:10008 COUNTY ROAD X61
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-9481
Practice Address - Country:US
Practice Address - Phone:563-260-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152608163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine