Provider Demographics
NPI:1053822551
Name:WANGUI, LEAH W (FNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:W
Last Name:WANGUI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MYSTIC CV
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-9654
Mailing Address - Country:US
Mailing Address - Phone:314-583-4665
Mailing Address - Fax:
Practice Address - Street 1:225 MYSTIC CV
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-9654
Practice Address - Country:US
Practice Address - Phone:314-583-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily