Provider Demographics
NPI:1487275616
Name:BRANCH, CHARNIECE
Entity type:Individual
Prefix:
First Name:CHARNIECE
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 NEBRASKA PL
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4058
Mailing Address - Country:US
Mailing Address - Phone:216-414-7181
Mailing Address - Fax:
Practice Address - Street 1:413 NEBRASKA PL
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4058
Practice Address - Country:US
Practice Address - Phone:216-414-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide