Provider Demographics
NPI:1861985921
Name:BRADFORD, GLADYS L (CNA)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:L
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 DAVID RAINES RD APT 118
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-5857
Mailing Address - Country:US
Mailing Address - Phone:318-268-2008
Mailing Address - Fax:
Practice Address - Street 1:1670 DAVID RAINES RD APT 118
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-5857
Practice Address - Country:US
Practice Address - Phone:318-268-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant