Provider Demographics
NPI:1902283781
Name:BRAGG, DANYELL LATRICE
Entity Type:Individual
Prefix:
First Name:DANYELL
Middle Name:LATRICE
Last Name:BRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 RAILROAD ST
Mailing Address - Street 2:323 A
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3508
Mailing Address - Country:US
Mailing Address - Phone:313-728-1022
Mailing Address - Fax:
Practice Address - Street 1:950 RAILROAD ST
Practice Address - Street 2:323 A
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3508
Practice Address - Country:US
Practice Address - Phone:313-728-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other