Provider Demographics
NPI:1871244871
Name:BRANNIGAN, DEANNA ROSE BOVA (APN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ROSE BOVA
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1617
Mailing Address - Country:US
Mailing Address - Phone:845-623-8031
Mailing Address - Fax:
Practice Address - Street 1:446 ROUTE 304
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1617
Practice Address - Country:US
Practice Address - Phone:845-623-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383339363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics