MEDICARE: MRS. CARLA RENEE BONDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	T200221023	MO

General Provider Information

NPI Number	:	1275050866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLA RENEE BONDS

Provider Business Mailing Address
First Line	:	906 MORRISON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3537
Country	:	US
Telephone Number	:	314-241-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 MORRISON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3537
Country	:	US
Telephone Number	:	314-241-1552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	07/21/2022

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