Provider Demographics
NPI:1841269529
Name:BRANAGAN, MICHELE DENISE (NP-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:BRANAGAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROLFE SQUARE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:401-725-8400
Mailing Address - Fax:401-725-8402
Practice Address - Street 1:30 ROLFE SQUARE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-725-8400
Practice Address - Fax:401-725-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37094363LG0600X, 363LA2200X
RIAPRN01327363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058066Medicaid
RI7058066Medicaid
RIQ52326Medicare UPIN
RI389004273Medicare ID - Type Unspecified