Individual
WAYNE E BRANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(815) 489-4400
Mailing address
PO BOX 1567, ROCKFORD, IL 61110-0067
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
041224814
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010122910
BLUE CROSS
IL
Enumeration date
12/18/2008
Last updated
12/18/2008
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