Nichole Renee Bradley, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

123392 Issued in OH

Practice address

8980 W State Route 163 Lot 37
Oak Harbor, OH 43449-9566

Phone

(419) 707-1718

NPI assigned

Feb 20, 2023

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 20, 2023.

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1134827157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8980 W STATE ROUTE 163 LOT 37",
            "city": "OAK HARBOR",
            "state": "OH",
            "postal_code": "434499566",
            "telephone_number": "419-707-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8980 W STATE ROUTE 163 LOT 37",
            "city": "OAK HARBOR",
            "state": "OH",
            "postal_code": "434499566",
            "telephone_number": "419-707-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "NICHOLE",
        "middle_name": "RENEE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "123392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnie E Bixler
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• Danielle Boaz, PTA
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• Sean Patrick Callahan, M.D.
• Carroll Township Trustees
• Co-Pilot Counseling

• All providers in Oak Harbor, OH
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.