Individual
PHYLLIS ELAINE BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5546 THORNBRIAR LN, FORT WAYNE, IN 46835-3890
(260) 750-2074
Mailing address
3103 E STATE BLVD, FORT WAYNE, IN 46805-4738
(260) 373-9330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003158B
IN
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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