Healthcare Provider Details

I. General information

NPI: 1437584091
Provider Name (Legal Business Name): FNU NEHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SAINT MAARTENS DR STE F
SAINT JOSEPH MO
64506-2990
US

IV. Provider business mailing address

4817 N CREEKWOOD DR
SAINT JOSEPH MO
64507-5207
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-8145
  • Fax: 816-279-1840
Mailing address:
  • Phone: 773-402-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2023003573
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.063673
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023003573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: