Provider Demographics
NPI:1083229751
Name:BRANAM, JENNA J (CNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:J
Last Name:BRANAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N VANDEMARK RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3567
Mailing Address - Country:US
Mailing Address - Phone:937-622-7393
Mailing Address - Fax:937-667-5002
Practice Address - Street 1:1101 N VANDEMARK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3567
Practice Address - Country:US
Practice Address - Phone:937-622-7393
Practice Address - Fax:937-667-5002
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.422570163W00000X
OHAPRN.CNP.0028292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435665Medicaid
MB6280173OtherDEA