Provider Demographics
NPI:1770794869
Name:BRANCA, JAMES (PNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BRANCA
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 63B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8251
Mailing Address - Country:US
Mailing Address - Phone:314-966-0111
Mailing Address - Fax:314-336-0008
Practice Address - Street 1:621 S NEW BALLAS RD STE 63B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8251
Practice Address - Country:US
Practice Address - Phone:314-966-0111
Practice Address - Fax:314-336-0008
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO121132164W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No164W00000XNursing Service ProvidersLicensed Practical Nurse