Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1093337875 |
---|---|
Provider Name | Allie Rose Branham |
First Address | Westerville, OH 43081-5676 |
Second Address | Marion, OH 43302-6225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2020 |
Last Update Date | 14/05/2020 |