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Individual

MR. RICKY WAYNE BRAGG JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
MDIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C, TACOMA, WA 98431-1100
(253) 968-1110
Mailing address
MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C, TACOMA, WA 98431-1100

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LP00056294
WA
164X00000X
Licensed Vocational Nurse
Primary
186791
TX

Other

Enumeration date
10/31/2017
Last updated
10/31/2017
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