Healthcare Provider Details

I. General information

NPI: 1619177912
Provider Name (Legal Business Name): ANDREW ANDERSON BRANKER RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

2200 STANDIFORD AVE 342
MODESTO CA
95350-6539
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 209-576-8605
  • Fax: 209-576-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number634138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: