Basic Information
| Provider Information | |||||||||
| NPI: | 1841539616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADLE | ||||||||
| FirstName: | DARLA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN, CNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 E STATE ST | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611041573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159888500 | ||||||||
| FaxNumber: | 8159775956 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 E STATE ST | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611041573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159888500 | ||||||||
| FaxNumber: | 8159775956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2013 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SC0200X | 209.003000 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Critical Care Medicine |
No ID Information.