Provider Demographics
NPI:1871155093
Name:UGWUEKE, ANN PERPERTUA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:PERPERTUA
Last Name:UGWUEKE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:ANASTECIA (ANN)
Other - Middle Name:PERPETUA
Other - Last Name:UGWUEKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:3921 S COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4328
Mailing Address - Country:US
Mailing Address - Phone:314-814-9980
Mailing Address - Fax:
Practice Address - Street 1:2101 CORONA RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2582
Practice Address - Country:US
Practice Address - Phone:573-234-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030763363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012000547OtherMO RN LICENSE
MO2019030763OtherAGPCNP-BC
MO195504912799OtherBLS
MO196504956364OtherACLS