Provider Demographics
NPI:1275396376
Name:CHUKWUYEM, EMMANUELSON (APRN)
Entity type:Individual
Prefix:
First Name:EMMANUELSON
Middle Name:
Last Name:CHUKWUYEM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0449
Mailing Address - Country:US
Mailing Address - Phone:800-345-5407
Mailing Address - Fax:636-386-5386
Practice Address - Street 1:4801 WELDON SPRING PKWY
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9101
Practice Address - Country:US
Practice Address - Phone:800-345-5407
Practice Address - Fax:636-386-5386
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024004076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily