Healthcare Provider Details

I. General information

NPI: 1184681934
Provider Name (Legal Business Name): MERRY A BRANTLEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE AYRES CIRCLE, BUILDING H-1, PORTSMOUTH NAVAL SHIPYD NAVAL HEALTH CARE NEW ENGLAND, BRANCH CLINIC
PORTSMOUTH NH
03804-5000
US

IV. Provider business mailing address

ONE AYRES CIRCLE, BUILDING H-1, PORTSMOUTH NAVAL SHIPYD NAVAL HEALTH CARE NEW ENGLAND, BRANCH CLINIC
PORTSMOUTH NH
03804-5000
US

V. Phone/Fax

Practice location:
  • Phone: 207-438-2081
  • Fax: 207-438-1754
Mailing address:
  • Phone: 207-438-2081
  • Fax: 207-438-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA404
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: