Provider Demographics
NPI:1740504232
Name:BRANSBY, PRISCILLA VANESSA (FNP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:VANESSA
Last Name:BRANSBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:VANESSA
Other - Last Name:PAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:818-790-7100
Mailing Address - Fax:
Practice Address - Street 1:1812 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:818-790-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871689315OtherNPI-CHAP
CAHAP70768FMedicaid
CAEAP70768FMedicaid
CAFHC70768FMedicaid
CAEAP70768FMedicaid