Individual
MISSY BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 PITTS ST, KERNERSVILLE, NC 27284-2670
(336) 341-5568
Mailing address
204 PITTS ST, KERNERSVILLE, NC 27284-2670
(336) 341-5568
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
946723808K
—
NC
Enumeration date
11/27/2018
Last updated
11/27/2018
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