Healthcare Provider Details

I. General information

NPI: 1457741175
Provider Name (Legal Business Name): EBERECHI OSUAGWU APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W 36TH AVE
KANSAS CITY KS
66103-2107
US

IV. Provider business mailing address

2205 W 36TH AVE
KANSAS CITY KS
66103-2107
US

V. Phone/Fax

Practice location:
  • Phone: 913-956-5620
  • Fax: 913-362-0431
Mailing address:
  • Phone: 913-956-5620
  • Fax: 913-362-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76697-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: