MEDICARE: MRS. CHARITY WAMBUI NYUGUTO FNPC

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	363LF0000X	Family Nurse Practitioner	209025112	IL
2	363LF0000X	Family Nurse Practitioner	2012013378	MO

General Provider Information

NPI Number	:	1013663160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARITY WAMBUI NYUGUTO FNPC

Provider Business Mailing Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-257-0780
Fax Number	:	618-234-7242

Provider Business Practice Location Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-257-0780
Fax Number	:	618-234-7242

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

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	07/28/2022

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