Provider Demographics
NPI:1477037695
Name:BRANCH, VICTORIA MARIE-VERKEST (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE-VERKEST
Last Name:BRANCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:VERKEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33301 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0905
Mailing Address - Country:US
Mailing Address - Phone:248-642-9111
Mailing Address - Fax:
Practice Address - Street 1:33301 WOODWARD AVENUE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-4800
Practice Address - Country:US
Practice Address - Phone:248-642-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant