Provider Demographics
NPI:1417174590
Name:BRANHAM, ROBIN LYNN
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LYNN
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 1:934 FAUSTINA AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2809
Mailing Address - Country:US
Mailing Address - Phone:419-562-6299
Mailing Address - Fax:
Practice Address - Street 1:934 FAUSTINA AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2809
Practice Address - Country:US
Practice Address - Phone:419-562-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632995Medicaid