BRADLEY RUSSELL WILSON (NPI# 1508339987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508339987 |
| Entity Type | Individual |
| Full Name | BRADLEY RUSSELL WILSON |
| Credential | FNP |
| Practice Address |
22101 Moross Rd Detroit MI 48236-2148 |
| Mailing Address |
36251 Alfred St New Baltimore MI 48047-2106 |
| Practice Telephone | 3133433660 |
| Mailing Telephone | 5868406016 |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2019-01-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
470429662 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235519984 | Bradley Craig Wilson | Military Health Care Provider | 2807 Montclair Ave, Pascagoula, MS 39567-5287 | 2015-06-08 |
| 1699061598 | Bradley Paul Wilson | Student in an Organized Health Care Education/Training Program | 349 17th Ave, San Francisco, CA 94121-2312 | 2011-06-20 |
| 1407084791 | Bradley Allen Wilson | Urology | 500 E Robinson Suite 1300, Norman Urology Associates, PC, Norman, OK 73071-6694 | 2009-06-25 |
| 1053329185 | Bradley Rix Wilson | Dentist | 2077 S Gessner Rd, Suite 125, Houston, TX 77063-1147 | 2006-08-04 |
| 1528046141 | Bradley A Wilson | Surgery | 1000 Health Center Dr Ste 101, Mattoon, IL 61938-4644 | 2006-01-04 |
| 1225020878 | Bradley C Wilson | Family Medicine | 7756 State Route 37 E, New Lexington, OH 43764-9512 | 2005-08-19 |
| 1366078990 | Bradley Clark Wilson | Case Manager/Care Coordinator | 2005 Ashland Ave, Toledo, OH 43620-1703 | 2020-03-16 |
| 1386985133 | Bradley W Wilson | Nurse Anesthetist, Certified Registered | 300 North Ave, Battle Creek, MI 49017-3307 | 2013-03-04 |
| 1609130954 | Bradley Lyle Wilson | Family Medicine | 4771 S Cleveland Ave, Fort Myers, FL 33907 | 2012-07-02 |
| 1174810824 | Bradley Jay Wilson | Radiology | 11800 E 12 Mile Rd, Warren, MI 48093-3472 | 2011-07-01 |
| Street Address |
22101 MOROSS RD |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083609887 | Anne M Schneider | Obstetrics & Gynecology | 22101 Moross Rd, 313, Detroit, MI 48236-2148 | 2005-09-19 |
| 1346848827 | Tanya L Locke | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-15 |
| 1588261556 | Ryan Guthrie | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-02 |
| 1578160743 | Lauren Kudirka | Speech-Language Pathologist | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-01 |
| 1952918740 | Lisa Colombo | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1124635917 | Gjergj George Juncaj | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1194337881 | Lori Holaly | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-23 |
| 1548870066 | Tamara Siblini | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-10 |
| 1104436583 | David Mark Thomas | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-31 |
| 1780293969 | Alexander Swend Mortensen | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386243574 | Carl Andrew Ballard | Nurse Practitioner | 2635 Johnson Bottom Rd, Detroit, AL 35552-2731 | 2020-10-20 |
| 1639776164 | Jennifer N Fucile | Nurse Practitioner | 3800 Woodward Ave Apt 702, Detroit, MI 48201-1980 | 2020-10-07 |
| 1649880329 | Dedra Delane Ford | Nurse Practitioner | 18255 Birchcrest Dr, Detroit, MI 48221-2750 | 2020-08-06 |
| 1528695624 | Venvisor Health Michigan LLC | Nurse Practitioner | 400 Renaissance Ctr Ste 200, Detroit, MI 48243-1502 | 2020-03-26 |
| 1558909978 | Ruxandra Maria Lazar | Nurse Practitioner | 5285 Anthony Wayne Dr, Detroit, MI 48202-3947 | 2019-12-16 |
| 1376186460 | Fazila Mahmood Siddiqui | Nurse Practitioner | 22201 Moross Rd Bldg Suite380, Detroit, MI 48236-2169 | 2019-10-22 |
| 1205482692 | Ladawn Denise Kennedy | Nurse Practitioner | 16645 Ilene St, Detroit, MI 48221-3401 | 2019-08-13 |
| 1427600246 | Christina Neirinck | Nurse Practitioner | 2401 St Antoine St, Detroit, MI 48201 | 2019-07-11 |
| 1548821556 | Ty R Houston | Nurse Practitioner | 13100 Corbett St, Detroit, MI 48213-2081 | 2019-06-21 |
| 1235795451 | Nekisha Bailey | Nurse Practitioner | 7501 Parkland, Detroit, MI 48239-1079 | 2019-05-13 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.