Healthcare Provider Details

I. General information

NPI: 1225414410
Provider Name (Legal Business Name): BRANKICA PODRAVAC CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MARMION AVE
YOUNGSTOWN OH
44502
US

IV. Provider business mailing address

320 HIGH ST NE
WARREN OH
44481-1222
US

V. Phone/Fax

Practice location:
  • Phone: 330-782-5664
  • Fax:
Mailing address:
  • Phone: 330-394-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA 17917 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: