MEDICARE: DR. CLARA AMPADU FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209015985	IL
2	363LF0000X	Family Nurse Practitioner	2017008662	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578096806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARA AMPADU FNP-C

Provider Business Mailing Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-257-0780
Fax Number	:	618-257-0715

Provider Business Practice Location Address
First Line	:	15 PARK PL
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2918
Country	:	US
Telephone Number	:	618-580-1359
Fax Number	:	618-234-7242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	06/28/2021

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