Healthcare Provider Details

I. General information

NPI: 1346178084
Provider Name (Legal Business Name): BRANCH FAMILY MEDICINE & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 W 177TH ST STE 3H
HAZEL CREST IL
60429-2186
US

IV. Provider business mailing address

18300 S HALSTED ST STE B
GLENWOOD IL
60425-1051
US

V. Phone/Fax

Practice location:
  • Phone: 708-816-4418
  • Fax: 949-818-7145
Mailing address:
  • Phone: 708-816-4418
  • Fax: 949-818-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LARINA BRANCH
Title or Position: OWNER
Credential: DNP, FNP-BC
Phone: 708-816-4418