Healthcare Provider Details

I. General information

NPI: 1427155571
Provider Name (Legal Business Name): JODY VERA BRANHAM C.N.M., M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 PARK WAY
MILL VALLEY CA
94941-2673
US

IV. Provider business mailing address

506 PARK WAY
MILL VALLEY CA
94941-2673
US

V. Phone/Fax

Practice location:
  • Phone: 415-272-3312
  • Fax: 415-924-1375
Mailing address:
  • Phone: 415-272-3312
  • Fax: 415-924-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number866
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number415189
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number415189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: