Healthcare Provider Details

I. General information

NPI: 1851361943
Provider Name (Legal Business Name): BLANCHE LENORA BRAGG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6865 W TROPICANA
LAS VEGAS NV
89103
US

IV. Provider business mailing address

4165 30TH AVE S SUITE 101
FARGO ND
58104-8419
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax: 866-397-7399
Mailing address:
  • Phone: 866-825-3227
  • Fax: 866-397-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN000739
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: