Provider Demographics
NPI:1407667819
Name:BRANNAN, JAY (RN)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:BRANNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:34 DEER RUN CIR
Mailing Address - Street 2:
Mailing Address - City:MCCOOK LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57049-4082
Mailing Address - Country:US
Mailing Address - Phone:605-323-5453
Mailing Address - Fax:
Practice Address - Street 1:380 W ANCHOR DR
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5273
Practice Address - Country:US
Practice Address - Phone:605-323-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR036821163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health