Provider Demographics
NPI:1467598318
Name:BRANNIGAN, DANA MARIE (MS, PA-C)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:SPERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:5 HUTTON CENTRE DR STE 950
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8714
Mailing Address - Country:US
Mailing Address - Phone:855-434-7763
Mailing Address - Fax:949-281-5550
Practice Address - Street 1:5 HUTTON CENTRE DR STE 950
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-8714
Practice Address - Country:US
Practice Address - Phone:855-434-7763
Practice Address - Fax:949-281-5550
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052459363AM0700X
CA54631363AM0700X
PAOA000884363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61640Medicare UPIN
PAQ61640Medicare UPIN