Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | MW008344L | PA |
NPI | 1033106679 |
---|---|
Provider Name | Mary S Bragg |
First Address | Williamsport, PA 17701-2627 |
Second Address | Lewistown, PA 17044-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 07/04/2016 |