Provider Demographics
NPI:1073838710
Name:BRANIFF, ANDREA LYNN (LDN, RD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:BRANIFF
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3232
Mailing Address - Country:US
Mailing Address - Phone:318-375-3235
Mailing Address - Fax:
Practice Address - Street 1:1000 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3232
Practice Address - Country:US
Practice Address - Phone:318-375-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA814053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered