Healthcare Provider Details

I. General information

NPI: 1417864372
Provider Name (Legal Business Name): TAMARA BRAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 27TH ST SE LOT 1011
MINOT ND
58701-5216
US

IV. Provider business mailing address

1325 27TH ST SE LOT 1011
MINOT ND
58701-5216
US

V. Phone/Fax

Practice location:
  • Phone: 701-389-2265
  • Fax:
Mailing address:
  • Phone: 701-389-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: