Provider Demographics
NPI:1427155571
Name:BRANHAM, JODY VERA (CNM, MSN)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:VERA
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2673
Mailing Address - Country:US
Mailing Address - Phone:415-272-3312
Mailing Address - Fax:415-924-1375
Practice Address - Street 1:506 PARK WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2673
Practice Address - Country:US
Practice Address - Phone:415-272-3312
Practice Address - Fax:415-924-1375
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7389363LW0102X
CA866367A00000X
CA415189163WW0101X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163W00000XNursing Service ProvidersRegistered Nurse