Provider Demographics
NPI:1841076395
Name:BRANNON, TERESA ANNE (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:B
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:404 IRISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTEDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12857-2110
Mailing Address - Country:US
Mailing Address - Phone:518-524-6685
Mailing Address - Fax:
Practice Address - Street 1:1466 COUNTY ROUTE 29
Practice Address - Street 2:
Practice Address - City:OLMSTEDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12857
Practice Address - Country:US
Practice Address - Phone:518-251-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633485163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool