Healthcare Provider Details

I. General information

NPI: 1699957597
Provider Name (Legal Business Name): FELICIA EKWUTOSI ANUNOBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

IV. Provider business mailing address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2900
  • Fax: 660-248-1544
Mailing address:
  • Phone: 660-248-2900
  • Fax: 660-248-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number150604
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: