Individual
SAMANTHA BRANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2102 W BETHANY HOME RD, PHOENIX, AZ 85015-1935
(602) 774-4745
Mailing address
16130 W JACKSON ST, GOODYEAR, AZ 85338-2886
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699146910
AETNA, MEDICARE
AZ
Enumeration date
04/15/2021
Last updated
04/15/2021
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