MEDICARE: MRS. ANDREA LYNN BRANIFF LDN, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	814053	LA

General Provider Information

NPI Number	:	1073838710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNN BRANIFF LDN, RD

Provider Business Mailing Address
First Line	:	1000 S SPRUCE ST
Second Line	:
City	:	VIVIAN
State	:	LA
Zip	:	71082-3232
Country	:	US
Telephone Number	:	318-375-3235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S SPRUCE ST
Second Line	:
City	:	VIVIAN
State	:	LA
Zip	:	71082-3232
Country	:	US
Telephone Number	:	318-375-3235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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