Provider Demographics
NPI:1760043228
Name:BRANAGH, MIESHA V
Entity Type:Individual
Prefix:
First Name:MIESHA
Middle Name:V
Last Name:BRANAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 COLOMBARD CIR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6171
Mailing Address - Country:US
Mailing Address - Phone:209-443-4117
Mailing Address - Fax:
Practice Address - Street 1:1902 COLOMBARD CIR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6171
Practice Address - Country:US
Practice Address - Phone:209-443-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health