Provider Demographics
NPI:1518327790
Name:OSOEGO, DARA (FNP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:OSOEGO
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 1:525 N. KEENE ST
Mailing Address - Street 2:STE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6967
Mailing Address - Country:US
Mailing Address - Phone:573-449-2141
Mailing Address - Fax:573-875-2328
Practice Address - Street 1:1600 E. BDWY.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-8000
Practice Address - Fax:573-557-2401
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily