Healthcare Provider Details

I. General information

NPI: 1205278579
Provider Name (Legal Business Name): KATIE ELAINE BRAGG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DRIVE WWKMHCC INDIAN HEALTH SERVICE
SISSETON SD
57262
US

IV. Provider business mailing address

100 LAKE TRAVERSE DRIVE WWKMHCC INDIAN HEALTH SERVICE
SISSETON SD
57262
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax: 605-742-0182
Mailing address:
  • Phone: 605-698-7606
  • Fax: 605-742-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR037047
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: