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General NPI Number Information
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NPI Number | 1386206845
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Entity Type | Individual
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Provider Name | DR. ADAUGO N NWANGUMA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 13013 FULLER AVE STE A
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City | GRANDVIEW
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State | MO
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Zip | 64030-2687
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Country | US
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Telephone | 816-214-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 4434 WORTHINGTON PLACE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63129-3732
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Country | US
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Telephone | 281-661-0850
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2019016848
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License Number State | MO
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