Provider Demographics
NPI:1235105735
Name:BRAGER, LONA WELBOURN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LONA
Middle Name:WELBOURN
Last Name:BRAGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LONA
Other - Middle Name:MARIE
Other - Last Name:KRUTZFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:921 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-682-5451
Mailing Address - Fax:641-682-0511
Practice Address - Street 1:921 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-682-5451
Practice Address - Fax:641-682-0511
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC067795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12754Medicare UPIN