Provider Demographics
NPI:1417544073
Name:BRANHAM, EDNA LAJUAN
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:LAJUAN
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 1:223 ORANGE ST SE APT B1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1767
Mailing Address - Country:US
Mailing Address - Phone:240-441-3787
Mailing Address - Fax:
Practice Address - Street 1:223 ORANGE ST SE APT B1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1767
Practice Address - Country:US
Practice Address - Phone:202-803-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant