MEDICARE: BRANCH WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1053297143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANCH WELLNESS LLC

Provider Business Mailing Address
First Line	:	5201 N 19TH AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2901
Country	:	US
Telephone Number	:	602-859-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 N 19TH AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2901
Country	:	US
Telephone Number	:	602-704-4130
Fax Number	:

Authorized Official
Title or Position	:	NP/OWNER
Name	:	DR. LAWANDA DUPREE
Credential	:	NP
Telephone Number	:	602-704-4130

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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Directions to “BRANCH WELLNESS LLC ” Practice Location

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