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General NPI Number Information
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NPI Number | 1174723282
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Entity Type | Individual
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Provider Name | LAVONNA JEANNENE BRANKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 210 EAST 64TH STREET 4TH FLOOR WECARE CLINIC
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-702-7579
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 ARLINGTON AVE APT.#18E
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City | BRONX
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State | NY
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Zip | 10471-1302
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Country | US
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Telephone | 718-796-7799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 199358
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License Number State | NY
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