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General NPI Number Information
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NPI Number | 1104400837
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Entity Type | Individual
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Provider Name | ILUNGA KATAMBWA NP
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Gender | Male
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 01/13/2024
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Provider Practice Location Address
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Address Line | 1621 N 1ST ST
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1299
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Country | US
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Telephone | 314-922-1822
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 LUNENBURG DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-8166
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Country | US
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Telephone | 314-922-1822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2023035006
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2021016520
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License Number State | MO
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