Provider Demographics
NPI:1760420400
Name:BRANSON, SHEILA (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 MCLAWS CIR
Practice Address - Street 2:STE 105
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5674
Practice Address - Country:US
Practice Address - Phone:757-941-5600
Practice Address - Fax:757-564-0557
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1425958Medicaid
LA4H581CQ50Medicare ID - Type Unspecified