Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MA061773 | PA |
NPI | 1114525367 |
---|---|
Provider Name | Madison Brannon |
First Address | Easton, PA 18042-6986 |
Second Address | Philadelphia, PA 19104-4551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2020 |
Last Update Date | 10/10/2020 |