1871155093 NPI number — ANN PERPERTUA UGWUEKE AGPCNP-BC

Table of content: ANN PERPERTUA UGWUEKE AGPCNP-BC (NPI 1871155093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871155093 NPI number — ANN PERPERTUA UGWUEKE AGPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGWUEKE
Provider First Name:
ANN
Provider Middle Name:
PERPERTUA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UGWUEKE
Provider Other First Name:
ANASTECIA (ANN)
Provider Other Middle Name:
PERPETUA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871155093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3921 S COMPTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63118-4328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-814-9980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CORONA RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-2582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-234-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  2019030763 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 2019030763 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2012000547 . This is a "MO RN LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2019030763 . This is a "AGPCNP-BC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 195504912799 . This is a "BLS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 196504956364 . This is a "ACLS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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