Provider Demographics
NPI:1447581921
Name:BRANN, DIANNA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:MARIE
Last Name:BRANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DIANNA
Other - Middle Name:MARIE
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11525 SOUTHARD RD
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033-3309
Mailing Address - Country:US
Mailing Address - Phone:315-626-6644
Mailing Address - Fax:
Practice Address - Street 1:180 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-255-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY470572-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse