Provider Demographics
NPI:1063826238
Name:BRANOM, RAQUEL (DNP, RN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:BRANOM
Suffix:
Gender:F
Credentials:DNP, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25334 PODERIO DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4716
Mailing Address - Country:US
Mailing Address - Phone:760-789-8534
Mailing Address - Fax:
Practice Address - Street 1:25334 PODERIO DR
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4716
Practice Address - Country:US
Practice Address - Phone:760-789-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383596163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care