Healthcare Provider Details

I. General information

NPI: 1649003815
Provider Name (Legal Business Name): NMAJU AZU OBASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROGRESS POINT PKWY
O FALLON MO
63368-2205
US

IV. Provider business mailing address

521 BROOKSIDE FOREST CT
O FALLON MO
63366-5089
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-1000
  • Fax:
Mailing address:
  • Phone: 314-327-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019024149
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: