Provider Demographics
NPI:1467200568
Name:BARRAGAN, BRENDA DIANE (MA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:DIANE
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4177 S COLUMBIA RD APT 416
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7756
Mailing Address - Country:US
Mailing Address - Phone:320-491-9614
Mailing Address - Fax:
Practice Address - Street 1:4177 S COLUMBIA RD APT 416
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7756
Practice Address - Country:US
Practice Address - Phone:320-491-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program