Provider Demographics
NPI:1528058302
Name:BRANNEN, MARLENE A (CRNA)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:A
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202149
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-2149
Mailing Address - Country:US
Mailing Address - Phone:907-258-2149
Mailing Address - Fax:907-258-2147
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-258-2149
Practice Address - Fax:907-258-2147
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK22450163W00000X
CA485044163W00000X
HI42066163W00000X
NV23440163W00000X
OR092006532163W00000X, 367500000X
WA00126899163W00000X
AK255367500000X
CA1916367500000X
GA043265367500000X
NV00096367500000X
WAAP30005052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S41309Medicare UPIN
AKK152541Medicare PIN