Provider Demographics
NPI:1154704765
Name:BRANHAM, AMY M (LPN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 FAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-9797
Mailing Address - Country:US
Mailing Address - Phone:614-406-8024
Mailing Address - Fax:
Practice Address - Street 1:7055 FAYETTE DR
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-9797
Practice Address - Country:US
Practice Address - Phone:614-406-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-090464164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse