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NPI Code Detail

MEDICARE: MR. EVANS O OGEBOR RN

MEDICARE:  MR. EVANS O OGEBOR  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0400XCase Management Registered Nurse041400854IL

General Provider Information

NPI Number : 1013482470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVANS O OGEBOR RN
Provider Business Mailing Address
First Line : 600 W FULTON ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60661-1262
Country : US
Telephone Number : 312-526-2411
Fax Number : 312-526-2329
Provider Business Practice Location Address
First Line : 5159 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4931
Country : US
Telephone Number : 773-434-9216
Fax Number : 773-434-2670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2018
Last Update Date : 10/11/2018

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Directions to “ MR. EVANS O OGEBOR RN” Practice Location

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