1386732014 NPI number — DANA A. BRANNON ARNP

Table of content: DANA A. BRANNON ARNP (NPI 1386732014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386732014 NPI number — DANA A. BRANNON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANNON
Provider First Name:
DANA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEHR
Provider Other First Name:
DANA
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386732014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEPPNER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97836-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-676-9133
Provider Business Mailing Address Fax Number:
541-676-2905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 ANDERSON DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-533-6063
Provider Business Practice Location Address Fax Number:
360-533-2204
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30004226 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 201705445NP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9629130 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com