Provider Demographics
NPI:1053586115
Name:BRADIN, JACQUELINE (CRNA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BRADIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-4066
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:302-709-4497
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:2010 OLD WEST CHESTER PIKE
Practice Address - Street 2:SUITE 330
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-789-8070
Practice Address - Fax:610-789-9937
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN308619L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN308619LOtherRN308619L