Healthcare Provider Details

I. General information

NPI: 1609219922
Provider Name (Legal Business Name): FELISTER N MWANGI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 PIERPOINT LN
SAINT CHARLES MO
63303-4803
US

IV. Provider business mailing address

1104 PIERPOINT LN
SAINT CHARLES MO
63303-4803
US

V. Phone/Fax

Practice location:
  • Phone: 314-698-1324
  • Fax:
Mailing address:
  • Phone: 314-698-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041.409046
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: