Provider Demographics
NPI:1821504796
Name:BRAGER, BELINDA JENNIFER (MSN, RN, PHN, CSN)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:JENNIFER
Last Name:BRAGER
Suffix:
Gender:F
Credentials:MSN, RN, PHN, CSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9001
Mailing Address - Country:US
Mailing Address - Phone:209-754-2322
Mailing Address - Fax:209-754-2379
Practice Address - Street 1:3304 HWY 12
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9001
Practice Address - Country:US
Practice Address - Phone:209-754-2322
Practice Address - Fax:209-754-2379
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480933163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WP0200XNursing Service ProvidersRegistered NursePediatrics