Provider Demographics
NPI:1265776033
Name:BRANNAGAN, KAREN MARTHA (RN,BC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARTHA
Last Name:BRANNAGAN
Suffix:
Gender:F
Credentials:RN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 CLEVELAND RD W APT 306
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1472
Mailing Address - Country:US
Mailing Address - Phone:419-202-4128
Mailing Address - Fax:
Practice Address - Street 1:1321 CLEVELAND RD W APT 306
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1472
Practice Address - Country:US
Practice Address - Phone:419-202-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.298916-163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse