Healthcare Provider Details

I. General information

NPI: 1457322646
Provider Name (Legal Business Name): GLENDA MARCIA BRANCH FNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LOWES BLVD
GARYSBURG NC
27831-9748
US

IV. Provider business mailing address

620 LOWES BLVD
GARYSBURG NC
27831-9748
US

V. Phone/Fax

Practice location:
  • Phone: 252-519-2451
  • Fax: 252-519-2454
Mailing address:
  • Phone: 252-519-2451
  • Fax: 252-519-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5001617
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: