Basic Information
| Provider Information | |||||||||
| NPI: | 1508134396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANCH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2976 COTTON LN | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628019569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183225120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 RICKER RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628814263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.009208 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.