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General NPI Number Information
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NPI Number | 1184091431
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Entity Type | Individual
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Provider Name | WOGENE AMSALU
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Gender | Female
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 9628 MIDLAND BLVD
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City | OVERLAND
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State | MO
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Zip | 63114-3357
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Country | US
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Telephone | 314-779-6022
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 INDIAN TRAILS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-3109
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2018001284
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2002031108
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License Number State | MO
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