Healthcare Provider Details

I. General information

NPI: 1508403205
Provider Name (Legal Business Name): GLORY MGBOJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVENUE, MSC 8121-0022-07
ST. LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-0231
  • Fax:
Mailing address:
  • Phone: 314-747-0231
  • Fax: 314-747-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: