Provider Demographics
NPI:1275396376
Name:CHUKWUYEM, EMMANUELSON (APRN)
Entity Type:Individual
Prefix:
First Name:EMMANUELSON
Middle Name:
Last Name:CHUKWUYEM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SCENIC OAKS CT
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-3457
Mailing Address - Country:US
Mailing Address - Phone:314-349-8598
Mailing Address - Fax:
Practice Address - Street 1:1027 SCENIC OAKS CT
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3457
Practice Address - Country:US
Practice Address - Phone:314-349-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024004076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily