Healthcare Provider Details

I. General information

NPI: 1205652518
Provider Name (Legal Business Name): ALEXANDRIA N BRAGG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S RAINBOW BLVD
LAS VEGAS NV
89118-1859
US

IV. Provider business mailing address

6655 OCTAVE AVE
LAS VEGAS NV
89139-6749
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number831891
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: