Individual
SHIRLEY JEAN GRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN II,NREMT-B,CIC-C
Contact information
Practice address
2118 CHATALET LN, PUEBLO, CO 81005-4625
(719) 564-2000
Mailing address
202 LA VISTA RD, PUEBLO, CO 81005-2619
(719) 334-6584
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
EMT 511744
FL
164W00000X
Licensed Practical Nurse
Primary
PN.0047668
CO
Other
Enumeration date
03/23/2017
Last updated
03/23/2017
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