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General NPI Number Information
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NPI Number | 1285687053
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Entity Type | Individual
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Provider Name | GRETCHEN I. BRANNON PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 6010 S MASON MONTGOMERY RD
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City | MASON
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State | OH
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Zip | 45040-3706
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Country | US
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Telephone | 513-246-7000
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Fax | 513-202-6355
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Provider Business Mailing Address
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Address Line | 4600 WESLEY AVE N
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City | CINCINNATI
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State | OH
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Zip | 45212-2298
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Country | US
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Telephone | 513-246-7800
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Fax | 513-246-7852
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.001892
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License Number State | OH
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