Healthcare Provider Details

I. General information

NPI: 1962369876
Provider Name (Legal Business Name): LANA BRANCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 E EMPIRE ST STE D
BLOOMINGTON IL
61704-3709
US

IV. Provider business mailing address

2205 E EMPIRE ST STE D
BLOOMINGTON IL
61704-3709
US

V. Phone/Fax

Practice location:
  • Phone: 309-838-4179
  • Fax: 309-808-4936
Mailing address:
  • Phone: 309-838-4179
  • Fax: 309-808-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: