Individual
CODY E BILDERBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4 MEMORIAL DR STE 230B, ALTON, IL 62002-6705
(618) 463-7874
Mailing address
4 MEMORIAL DR STE 230B, ALTON, IL 62002-6705
(618) 463-7874
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2013012822
MO
363LF0000X
Family Nurse Practitioner
Primary
209010451
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013012822
MO LICENSE
MO
Enumeration date
06/10/2013
Last updated
05/09/2023
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