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General NPI Number Information
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NPI Number | 1851361943
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Entity Type | Individual
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Provider Name | BLANCHE LENORA BRAGG FNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 6865 W TROPICANA
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City | LAS VEGAS
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State | NV
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Zip | 89103
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Country | US
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Telephone | 866-825-3227
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Fax | 866-397-7399
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Provider Business Mailing Address
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Address Line | 4165 30TH AVE S SUITE 101
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City | FARGO
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State | ND
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Zip | 58104-8419
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Country | US
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Telephone | 866-825-3227
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Fax | 866-397-7399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN000739
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License Number State | NV
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