Individual provider · NPI-1

Lisa Charisee Bradley, Registered Nurse

Homemaker · Saint Louis, MO

NPI number1114486743
StatusActive
Last updated in NPPESMar 13, 2019

Details

NPI
1114486743
Entity type
Individual (NPI-1)
Name
Lisa Charisee Bradley
Credential
Registered Nurse
Sex
Female
Sole proprietor
No
Enumeration date
Mar 13, 2019
Last updated
Mar 13, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
376J00000X Homemaker–MOYes

Practice location

4135 Holman Ln
Saint Louis, MO 63134-3925

Phone 314-479-6121 · Fax 314-479-6121

Mailing address

4135 Holman Ln
Saint Louis, MO 63134-3925

Phone 314-479-6121 · Fax 314-479-6121

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