Provider Demographics
NPI:1174723282
Name:BRANKER, LAVONNA JEANNENE (MD)
Entity type:Individual
Prefix:DR
First Name:LAVONNA
Middle Name:JEANNENE
Last Name:BRANKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 ARLINGTON AVE
Mailing Address - Street 2:APT.#18E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1302
Mailing Address - Country:US
Mailing Address - Phone:718-796-7799
Mailing Address - Fax:
Practice Address - Street 1:210 EAST 64TH STREET
Practice Address - Street 2:4TH FLOOR WECARE CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-702-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199358207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine