MEDICARE: MISS CHRISTINA LEE BRANSCUM

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	171M00000X	Case Manager/Care Coordinator	8761120	AZ

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	:	1568966349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINA LEE BRANSCUM

Provider Business Mailing Address
First Line	:	3170 STILLWATER DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7151
Country	:	US
Telephone Number	:	928-777-3280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 W BIG CHINO RD
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-3143
Country	:	US
Telephone Number	:	928-777-3280
Fax Number	:

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

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/20/2018

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