Provider Demographics
NPI:1417496530
Name:BRAGG, DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8702
Mailing Address - Country:US
Mailing Address - Phone:740-891-0234
Mailing Address - Fax:
Practice Address - Street 1:5245 W SHORE DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8702
Practice Address - Country:US
Practice Address - Phone:740-891-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH221597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse