MEDICARE: LUCY WACHUKA KAMAU

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	363LF0000X	Family Nurse Practitioner	2020010565	MO

General Provider Information

NPI Number	:	1932728466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY WACHUKA KAMAU

Provider Business Mailing Address
First Line	:	4412 CLARENCE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3108
Country	:	US
Telephone Number	:	806-584-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 CLARENCE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3108
Country	:	US
Telephone Number	:	806-584-5498
Fax Number	:

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

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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