Individual
BRIANA WALDECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5213 GODFREY RD STE 110, GODFREY, IL 62035-2510
(618) 619-3330
(618) 619-3390
Mailing address
340 W LINCOLN ST, SUITE 500, BELLEVILLE, IL 62220-1900
(618) 277-7400
(618) 277-7422
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011703
IL
363LF0000X
Family Nurse Practitioner
209011703
IL
Other
Enumeration date
08/19/2014
Last updated
06/03/2024
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