Individual
REGINA BRANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
75 SOCKANOSSET CROSS RD, SUITE 100, CRANSTON, RI 02920-5558
(401) 946-6200
(401) 275-1992
Mailing address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NPP13640
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
709004045
GROUP MEDICARE
RI
05
—
9002852
—
RI
Enumeration date
09/14/2005
Last updated
09/16/2013
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