Provider Demographics
NPI:1063153120
Name:BRANCH, TAMARA MARIE (TRANSPORTAION)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:BRANCH
Suffix:
Gender:F
Credentials:TRANSPORTAION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 LAYMAN ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2561
Mailing Address - Country:US
Mailing Address - Phone:504-516-5736
Mailing Address - Fax:504-345-2928
Practice Address - Street 1:361 LAYMAN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2561
Practice Address - Country:US
Practice Address - Phone:504-516-5736
Practice Address - Fax:504-345-2928
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA731556677172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver