Provider Demographics
NPI:1710254719
Name:BRANSCUM, ANN (EDS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNM HEALTH SCIENCES CENTER, PSYCHIATRY/BEHAVIORAL SCI.
Mailing Address - Street 2:MSC009-5030, 1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6203
Mailing Address - Fax:
Practice Address - Street 1:UNM HEALTH SCIENCES CENTER, PSYCHIATRY/BEHAVIORAL SCI.
Practice Address - Street 2:MSC009-5030, 1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM346902103TS0200X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool