1508307000 NPI number — RACHEL COLLEEN LITTLE BRANAS PA-C

Table of content: RACHEL COLLEEN LITTLE BRANAS PA-C (NPI 1508307000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508307000 NPI number — RACHEL COLLEEN LITTLE BRANAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANAS
Provider First Name:
RACHEL
Provider Middle Name:
COLLEEN LITTLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
RACHEL
Provider Other Middle Name:
COLLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DIVORCED
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508307000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 BRIGHTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15074-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-774-7110
Provider Business Mailing Address Fax Number:
724-935-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CCP SEWICKLEY
Provider Second Line Business Practice Location Address:
111 HAZEL LANE SUIT 201
Provider Business Practice Location Address City Name:
SEWICKLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15143-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
725-774-7110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2017

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: 363A00000X , with the licence number:  MA058854 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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