Individual
MS. GWENDOLYN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
294 KINGS RIDGE BLVD, O FALLON, IL 62269-6330
(618) 975-3781
Mailing address
1811 SAN RICARDO DR, SAINT LOUIS, MO 63138-1942
(314) 306-4934
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043049025
IL
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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