Individual
MRS. CARLA JO WINTER-BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
104 SHORELINE CRT, ST. CHARLES, IL 60174
(331) 266-9676
Mailing address
104 SHORELINE CRT, ST. CHARLES, IL 60174
(406) 366-5070
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
209.022424
IL
207QA0505X
Adult Medicine Physician
MT-APRN-100450
MT
363LF0000X
Family Nurse Practitioner
NUR-RN-LIC 26699
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M011004857
MEDICARE PTAN
MT
01
—
NUR-LIN-LIC 26699
NURSING LICENSE
MT
Enumeration date
05/29/2007
Last updated
05/03/2023
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