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General NPI Number Information
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NPI Number | 1912550526
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Entity Type | Individual
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Provider Name | JUSTIN BRANHAM APRN
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Gender | Male
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 120-357-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10711
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License Number State | CT
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