Healthcare Provider Details

I. General information

NPI: 1336532225
Provider Name (Legal Business Name): SIMION BRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S KENT DES MOINES RD APT 39
DES MOINES WA
98198-7572
US

IV. Provider business mailing address

1625 S KENT DES MOINES RD APT 39
DES MOINES WA
98198-7572
US

V. Phone/Fax

Practice location:
  • Phone: 206-375-7521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 60454993
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: