Provider Demographics
NPI:1518945708
Name:BRANNIN, NANCY LOUISE (CNM)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LOUISE
Last Name:BRANNIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4332
Mailing Address - Country:US
Mailing Address - Phone:505-426-8646
Mailing Address - Fax:505-425-6475
Practice Address - Street 1:1900 HOT SPRINGS BLVD
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3481
Practice Address - Country:US
Practice Address - Phone:505-425-6425
Practice Address - Fax:505-425-6475
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM528367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8605530Medicaid
NM8605530Medicaid