Provider Demographics
NPI:1386870053
Name:BRANNAN, ELIZABETH MICHELLE (MSN, RN, CRNP-ACUTE)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:MSN, RN, CRNP-ACUTE
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:BRANNAN
Other - Last Name:MORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, ACNP-BC
Mailing Address - Street 1:8322 BELLONA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2065
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-821-1334
Practice Address - Street 1:8322 BELLONA AVE STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2065
Practice Address - Country:US
Practice Address - Phone:410-337-7900
Practice Address - Fax:410-821-1334
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185547163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036683800Medicaid
MD036683800Medicaid