1205919453 NPI number — MS. TONJA BRANHAM CST/CFA

Table of content: MS. TONJA BRANHAM CST/CFA (NPI 1205919453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205919453 NPI number — MS. TONJA BRANHAM CST/CFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANHAM
Provider First Name:
TONJA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CST/CFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205919453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 S. UTICA AVENUE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-579-1262
Provider Business Mailing Address Fax Number:
918-579-3826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 S. UTICA AVE.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-749-6400
Provider Business Practice Location Address Fax Number:
918-749-2168
Provider Enumeration Date:
10/23/2006

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: 246ZS0410X , with the licence number:  82714 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 82714 . This is a "SURGICAL TECHNOLOGIST CER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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