Provider Demographics
NPI:1932404332
Name:BRANHAM, TIM A (RN)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:A
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43753 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-8540
Mailing Address - Country:US
Mailing Address - Phone:740-669-8608
Mailing Address - Fax:
Practice Address - Street 1:43753 COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-8540
Practice Address - Country:US
Practice Address - Phone:740-669-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3249973747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant