MEDICARE: DR. NANCY LOUISE BRANNIN CNM

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	367A00000X	Advanced Practice Midwife	528	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518945708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY LOUISE BRANNIN CNM

Provider Business Mailing Address
First Line	:	918 5TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4332
Country	:	US
Telephone Number	:	505-426-8646
Fax Number	:	505-425-6475

Provider Business Practice Location Address
First Line	:	1900 HOT SPRINGS BLVD
Second Line	:	STE A
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3481
Country	:	US
Telephone Number	:	505-425-6425
Fax Number	:	505-425-6475

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	10/25/2011

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