Healthcare Provider Details

I. General information

NPI: 1154213486
Provider Name (Legal Business Name): BENEDICTINES OF LDW CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 CONNECTICUT ST
SAINT LOUIS MO
63118-2074
US

IV. Provider business mailing address

3536 CONNECTICUT ST
SAINT LOUIS MO
63118-2074
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-9980
  • Fax:
Mailing address:
  • Phone: 314-814-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANN UGWUEKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-814-9980