Healthcare Provider Details

I. General information

NPI: 1518687110
Provider Name (Legal Business Name): ADESUWA LILLIAN OBASOGIE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 E 63RD ST
KANSAS CITY MO
64130-3462
US

IV. Provider business mailing address

2323 E 63RD ST
KANSAS CITY MO
64130-3462
US

V. Phone/Fax

Practice location:
  • Phone: 816-217-2076
  • Fax:
Mailing address:
  • Phone: 816-217-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2007024270
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: