Healthcare Provider Details

I. General information

NPI: 1932875143
Provider Name (Legal Business Name): LAURA BRANNAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

IV. Provider business mailing address

32 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

V. Phone/Fax

Practice location:
  • Phone: 570-827-0145
  • Fax:
Mailing address:
  • Phone: 570-827-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH071714
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: