Healthcare Provider Details

I. General information

NPI: 1528058302
Provider Name (Legal Business Name): MARLENE A. BRANNEN C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEBARR RD
ANCHORAGE AK
99508-2932
US

IV. Provider business mailing address

PO BOX 202149
ANCHORAGE AK
99520-2149
US

V. Phone/Fax

Practice location:
  • Phone: 907-258-2149
  • Fax: 907-258-2147
Mailing address:
  • Phone: 907-258-2149
  • Fax: 907-258-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22450
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number485044
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number42066
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number23440
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number092006532
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00126899
License Number StateWA
# 7
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number255
License Number StateAK
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1916
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number043265
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number00096
License Number StateNV
# 11
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number092006532
License Number StateOR
# 12
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30005052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: