Marie Alena Bradley, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041.366108 Issued in IL

Practice address

2314 Monticello PL
Edwardsville, IL 62025-8006

Phone

(618) 972-2580

NPI assigned

Aug 16, 2023

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

• Marie Alena Fattore Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 16, 2023.

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1609659200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 MONTICELLO PL",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620258006",
            "telephone_number": "618-972-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 MONTICELLO PL",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620258006",
            "telephone_number": "618-972-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MARIE",
        "middle_name": "ALENA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.366108",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2013030160",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "FATTORE",
            "middle_name": "ALENA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Bonzelet, MD
• Derek Bowers, LMFT
• Makala Rene Boyles, BSN, RN
• Lauren Bozsa, OD
• Brad McMillin, Inc
• Nicole Brainin
• Lukas Dean Brase
• Bravo Care of Edwardsville Inc
• Elizabeth Marie Bray, MS, CCC-SLP
• Harvey Breckner, D.M.D., M.S.

• All providers in Edwardsville, IL
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.