Provider Demographics
NPI:1730362682
Name:BRADLEY, RACHELLE SOFIA (ND)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:SOFIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 PACIFIC ST STE 207
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5480
Mailing Address - Country:US
Mailing Address - Phone:402-391-6714
Mailing Address - Fax:
Practice Address - Street 1:7701 PACIFIC ST STE 207
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-391-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1232101YM0800X
NE485133N00000X
WANT00000399175F00000X
CAND-336175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No175F00000XOther Service ProvidersNaturopath