Healthcare Provider Details

I. General information

NPI: 1861048225
Provider Name (Legal Business Name): OTUOMASIRICHI EUDORAH ONYEMA DNP, MPH, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863A GRAVOIS AVE
SAINT LOUIS MO
63116-4657
US

IV. Provider business mailing address

PO BOX 740019
ATLANTA GA
30374-0019
US

V. Phone/Fax

Practice location:
  • Phone: 314-888-0981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019031652
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: