MEDICARE: MS. GRETCHEN I. BRANNON PA-C

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	363A00000X	Physician Assistant	50.001892	OH

General Provider Information

NPI Number	:	1285687053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRETCHEN I. BRANNON PA-C

Provider Business Mailing Address
First Line	:	4600 WESLEY AVE
Second Line	:	N
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2298
Country	:	US
Telephone Number	:	513-246-7800
Fax Number	:	513-246-7852

Provider Business Practice Location Address
First Line	:	6010 S MASON MONTGOMERY RD
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-3706
Country	:	US
Telephone Number	:	513-246-7000
Fax Number	:	513-202-6355

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/31/2014

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