Provider Demographics
NPI:1023112463
Name:BRANNIGAN, MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LEGHORN CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2857
Mailing Address - Country:US
Mailing Address - Phone:631-549-8681
Mailing Address - Fax:
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:160C
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-427-7553
Practice Address - Fax:631-547-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227651-1163WP0808X
NJ26NR02608100163WP0808X
PARN147743L163WP0808X
NYF301725-1363LA2200X
PATP005903C363LA2200X
NJ26NC02608100364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health