Basic Information
| Provider Information | |||||||||
| NPI: | 1427155571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANHAM | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | VERA | ||||||||
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| Credential: | C.N.M., M.S.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 PARK WAY | ||||||||
| Address2: | |||||||||
| City: | MILL VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949412673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152723312 | ||||||||
| FaxNumber: | 4159241375 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 PARK WAY | ||||||||
| Address2: | |||||||||
| City: | MILL VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949412673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152723312 | ||||||||
| FaxNumber: | 4159241375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 7389 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | 866 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 163WW0101X | 415189 | CA | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 163W00000X | 415189 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.