Basic Information
| Provider Information | |||||||||
| NPI: | 1215912001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANSON | ||||||||
| FirstName: | EDWARD | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1135 MORTON ST | ||||||||
| Address2: | |||||||||
| City: | MATTAPAN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021262834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175332300 | ||||||||
| FaxNumber: | 6175332341 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 NEPONSET AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021223134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172823200 | ||||||||
| FaxNumber: | 6172828201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 153494 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.