Individual
KATY HELENE WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C
Contact information
Practice address
1414 CROSS ST STE 240, SHILOH, IL 62269-2941
(618) 234-2390
(618) 234-9936
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 448-3791
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2019001390
MO
363L00000X
Nurse Practitioner
Primary
209018627
IL
363LF0000X
Family Nurse Practitioner
2019001390
MO
Other
Enumeration date
03/24/2020
Last updated
04/10/2024
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