Provider Demographics
NPI:1477115087
Name:MUTUMA, ROGOI LUCY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROGOI
Middle Name:LUCY
Last Name:MUTUMA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 NE DREAMWEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5854
Mailing Address - Country:US
Mailing Address - Phone:816-489-9085
Mailing Address - Fax:
Practice Address - Street 1:4600 COLLEGE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1606
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:913-297-1202
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily