Individual
JOHNNY BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1530 SAINT CLAIR AVE NE, CLEVELAND, OH 44114-2004
(216) 781-6724
Mailing address
1530 SAINT CLAIR AVE NE, CLEVELAND, OH 44114-2004
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.356075
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN.356075
LICENSE
OH
Enumeration date
12/21/2017
Last updated
12/21/2017
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