Provider Demographics
NPI:1093337875
Name:BRANHAM, ALLIE ROSE
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:ROSE
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 TANSY LN
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5676
Mailing Address - Country:US
Mailing Address - Phone:419-651-2322
Mailing Address - Fax:
Practice Address - Street 1:960 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6225
Practice Address - Country:US
Practice Address - Phone:740-383-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife