Provider Demographics
NPI:1285247981
Name:GONCALVES, BRANDEN R (RN)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:R
Last Name:GONCALVES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2425
Mailing Address - Country:US
Mailing Address - Phone:203-305-0323
Mailing Address - Fax:
Practice Address - Street 1:6 POPLAR DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2425
Practice Address - Country:US
Practice Address - Phone:203-305-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10.129517163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine