MEDICARE: PATRICK NWANNEDIMA ONWEAZU RN

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	163W00000X	Registered Nurse	2011021161	MO
2	363L00000X	Nurse Practitioner	2024019213	MO

General Provider Information

NPI Number	:	1740813518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK NWANNEDIMA ONWEAZU RN

Provider Business Mailing Address
First Line	:	4321 SE SEATTLE SLEW DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4933
Country	:	US
Telephone Number	:	816-872-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 SE SEATTLE SLEW DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4933
Country	:	US
Telephone Number	:	816-872-8354
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	07/24/2024

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