Healthcare Provider Details

I. General information

NPI: 1881910487
Provider Name (Legal Business Name): CHIMNOYA N NWAGWU-YOULO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHIMNOYA NWAGWU

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

1050 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-9000
  • Fax:
Mailing address:
  • Phone: 573-364-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0441190
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01075285
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020030113
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: