Provider Demographics
NPI:1164551420
Name:BRANZ, LINDA ELLEN (NP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELLEN
Last Name:BRANZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3205
Mailing Address - Country:US
Mailing Address - Phone:254-757-0434
Mailing Address - Fax:
Practice Address - Street 1:3115 PINE AVE
Practice Address - Street 2:SUITE 708
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3247
Practice Address - Country:US
Practice Address - Phone:254-754-0300
Practice Address - Fax:254-754-0301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561904363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health