Provider Demographics
NPI:1881910487
Name:NWAGWU-YOULO, CHIMNOYA N (MD)
Entity type:Individual
Prefix:MS
First Name:CHIMNOYA
Middle Name:N
Last Name:NWAGWU-YOULO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIMNOYA
Other - Middle Name:
Other - Last Name:NWAGWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:
Practice Address - Street 1:1050 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-364-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075285208M00000X
KS0441190207R00000X
MO2020030113208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000983476OtherANTHEM PIN
IN201291200Medicaid
ININ2762029Medicare PIN