Provider Demographics
NPI:1548877384
Name:HANER, BRANDEN LEE
Entity type:Individual
Prefix:MR
First Name:BRANDEN
Middle Name:LEE
Last Name:HANER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WATSON WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7213
Mailing Address - Country:US
Mailing Address - Phone:740-602-1276
Mailing Address - Fax:
Practice Address - Street 1:275 WATSON WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7213
Practice Address - Country:US
Practice Address - Phone:740-602-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5101286253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228256Medicaid