Provider Demographics
NPI:1841786878
Name:BRANCO, BLAIR E (CPNP-PC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:E
Last Name:BRANCO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2374
Mailing Address - Country:US
Mailing Address - Phone:419-668-1341
Mailing Address - Fax:
Practice Address - Street 1:282 BENEDICT AVE STE B
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2712
Practice Address - Country:US
Practice Address - Phone:419-668-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023406363LP0200X
OH023406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics