Provider Demographics
NPI:1407443633
Name:BRANHAM, RAINA SUE
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:SUE
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:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:PANTHER
Mailing Address - State:WV
Mailing Address - Zip Code:24872-0464
Mailing Address - Country:US
Mailing Address - Phone:304-938-5936
Mailing Address - Fax:
Practice Address - Street 1:1133 TRAP FORK RD.
Practice Address - Street 2:
Practice Address - City:PANTHER
Practice Address - State:WV
Practice Address - Zip Code:24872
Practice Address - Country:US
Practice Address - Phone:304-938-5936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant