Individual
WOGENE AMSALU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9628 MIDLAND BLVD, OVERLAND, MO 63114-3357
(314) 779-6022
Mailing address
1131 INDIAN TRAILS DR, SAINT LOUIS, MO 63132-3109
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2002031108
MO
363LP2300X
Primary Care Nurse Practitioner
Primary
2018001284
MO
Other
Enumeration date
08/21/2015
Last updated
05/11/2022
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