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: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 CRAWFORD AVE STE 220
OLYMPIA FIELDS IL
60461-1173
US

IV. Provider business mailing address

20303 CRAWFORD AVE STE 220
OLYMPIA FIELDS IL
60461-1173
US

V. Phone/Fax

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

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: NURSE PRACTITIONER
Credential: DNP, FNP
Phone: 708-816-4418