Provider Demographics
NPI:1003082611
Name:BRANSON, TONIA RENE'E (IPP/CNA)
Entity Type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:RENE'E
Last Name:BRANSON
Suffix:
Gender:F
Credentials:IPP/CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:SAVANNA
Mailing Address - State:OK
Mailing Address - Zip Code:74565-0036
Mailing Address - Country:US
Mailing Address - Phone:918-470-0959
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 152A
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-9514
Practice Address - Country:US
Practice Address - Phone:918-470-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200126080A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200126080Medicaid