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1184331902
JELYA INGRID FATAWU
WENTZVILLE, MO
NPI
1184331902
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: MO 2022035166)
Enumeration Date
2022-11-01
Last Update Date
2022-11-01
Business Address
Ms. JELYA INGRID FATAWU PMHMP-BC
4 LIBERTY GROVE CT
WENTZVILLE, MO 63385-7188
Phone number: 216-246-5697
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Mailing Address
Ms. JELYA INGRID FATAWU PMHMP-BC
4 LIBERTY GROVE CT
WENTZVILLE, MO 63385-7188
Phone number:
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