Provider Demographics
NPI:1619169547
Name:BRANHAM, ANN (RNC, MN, FNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:RNC, MN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3715
Mailing Address - Country:US
Mailing Address - Phone:803-359-3236
Mailing Address - Fax:803-359-5233
Practice Address - Street 1:811 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3715
Practice Address - Country:US
Practice Address - Phone:803-359-3236
Practice Address - Fax:803-359-5233
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily