Provider Demographics
NPI:1013663160
Name:NYUGUTO, CHARITY WAMBUI (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:WAMBUI
Last Name:NYUGUTO
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2918
Mailing Address - Country:US
Mailing Address - Phone:618-257-0780
Mailing Address - Fax:618-234-7242
Practice Address - Street 1:15 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2918
Practice Address - Country:US
Practice Address - Phone:618-257-0780
Practice Address - Fax:618-234-7242
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025112363LF0000X
MO2012013378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily