MEDICARE: NWAMAKA IFEYINWA ORJI

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025037120	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209034077	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G189793	IA

General Provider Information

NPI Number	:	1215760376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NWAMAKA IFEYINWA ORJI

Provider Business Mailing Address
First Line	:	12645 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6692
Country	:	US
Telephone Number	:	314-332-0387
Fax Number	:

Provider Business Practice Location Address
First Line	:	12645 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6692
Country	:	US
Telephone Number	:	314-512-7801
Fax Number	:

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	05/03/2026

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