Lisa Charisee Bradley, REGISTERED NURSE
Individual provider Active NPI Homemaker · Saint Louis, MO
NPI 1114486743 · NPPES record last updated Mar 13, 2019
Key facts
- NPI
- 1114486743
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- Practice address
- 4135 Holman LN
Saint Louis, MO 63134-3925 - Phone
- (314) 479-6121
- Fax
- (314) 479-6121
- NPI assigned
- Mar 13, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Infiniti Home Care, Inc. | Current |
Accepting new patients | |
| Infiniti Home Care, Inc. | Homemaker | Current | Accepting new patients |
| Infiniti Homecare Consumer Directed Services, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | MO | Yes |
Addresses
Primary practice location
4135 Holman LN
Saint Louis, MO 63134-3925
Mailing address
4135 Holman LN
Saint Louis, MO 63134-3925
Phone (314) 479-6121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431921811 | Medicaid | MO |
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.