Active NPI
Gwendolyn Bradley
- Licensed Practical Nurse
- O'Fallon, IL
National Provider Identifier
1578005955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 043049025
- Practice address
- 294 Kings Ridge Blvd
O Fallon, IL 62269-6330 - Phone
- (618) 975-3781
- NPI assigned
- Nov 16, 2016
- Last updated
- Nov 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043049025 | IL | Primary |
Addresses
Primary practice location
294 Kings Ridge Blvd
O Fallon, IL 62269-6330
Mailing address
1811 San Ricardo Dr
Saint Louis, MO 63138-1942
Phone (314) 306-4934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043049025 | IL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1578005955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1811 SAN RICARDO DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631381942",
"telephone_number": "314-306-4934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "294 KINGS RIDGE BLVD",
"city": "O FALLON",
"state": "IL",
"postal_code": "622696330",
"telephone_number": "618-975-3781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "GWENDOLYN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-16",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IL",
"license": "043049025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, IL
- Elizabeth Jpyce-Ruth Bowman, BEHAVIOR TECHNICIAN
- Tonya L. Bowman, D.M.D.
- Brad McMillin Inc (Beltone Hearing Aid Service)
- Brad McMillin, Inc (Beltone Hearing Aid Service)
- Benjamin Nathaniel Bradley
- Katherine Bradley, ATC
- Stacy Elizabeth Bragg, OTR
- Darci R Brannan
- Branz Nutrition Counseling
- Sarah Jane Brashear, FNP-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.