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General NPI Number Information
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NPI Number | 1093032716
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Entity Type | Organization
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Legal Business Name | PAULETTE C BRANCH
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 75959 VANDALIA LN # 104
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City | KIMBOLTON
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State | OH
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Zip | 43749-9785
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Country | US
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Telephone | 330-760-0605
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 755
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City | NEWCOMERSTOWN
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State | OH
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Zip | 43832-0755
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Country | US
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Telephone | 330-760-0606
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MRS. PAULETTE CATHERINE BRANCH
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Credential | LPN
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Telephone | 330-760-0605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | LPN139141
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License Number State | OH
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