Healthcare Provider Details

I. General information

NPI: 1356471510
Provider Name (Legal Business Name): CHERI SHANTEL WINN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

3325 SARATOGA DR
BELLEVILLE IL
62221-6633
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8000
  • Fax:
Mailing address:
  • Phone: 618-670-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1999141515
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: