Healthcare Provider Details

I. General information

NPI: 1841855335
Provider Name (Legal Business Name): GLADYS WATURI GITAU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

IV. Provider business mailing address

PO BOX 776874
CHICAGO IL
60677-6874
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5010
  • Fax:
Mailing address:
  • Phone: 314-291-7997
  • Fax: 314-739-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2019015944
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: