Individual
CRYSTAL BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C, FPA
Contact information
Practice address
4260 S STATE ROUTE 159 STE 1, GLEN CARBON, IL 62034-3201
(872) 713-7614
Mailing address
4335 WAGNER RD, MARINE, IL 62061-1253
(314) 306-5239
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
277.003238
IL
Other
Enumeration date
11/05/2020
Last updated
09/04/2024
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