Healthcare Provider Details

I. General information

NPI: 1740552058
Provider Name (Legal Business Name): BARBARA ANNE BRANCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-9325
  • Fax: 585-922-9335
Mailing address:
  • Phone: 585-922-0527
  • Fax: 585-922-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF- 301627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: