Individual
SHANDA ROSE BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDMS
Contact information
Practice address
6709 S MINNESOTA AVE, SUITE 203, SIOUX FALLS, SD 57108-2592
(605) 274-2525
(605) 274-0620
Mailing address
6709 S MINNESOTA AVE, SUITE 203, SIOUX FALLS, SD 57108-2592
(605) 274-2525
(605) 274-0620
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
2471S1302X
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101870
ARDMS
SD
Enumeration date
09/17/2013
Last updated
09/17/2013
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