Healthcare Provider Details

I. General information

NPI: 1841269529
Provider Name (Legal Business Name): MICHELE DENISE BRANAGAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROLFE SQUARE
CRANSTON RI
02910
US

IV. Provider business mailing address

30 ROLFE SQUARE
CRANSTON RI
02910
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-8400
  • Fax: 401-725-8402
Mailing address:
  • Phone: 401-725-8400
  • Fax: 401-725-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNPP37094
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37094
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN01327
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: