Healthcare Provider Details

I. General information

NPI: 1275049694
Provider Name (Legal Business Name): ISOKEN FRANCA OGBOMO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 SCHAFER AVE
BOLINGBROOK IL
60490-3230
US

IV. Provider business mailing address

402 W BOUGHTON RD STE A
BOLINGBROOK IL
60440-1998
US

V. Phone/Fax

Practice location:
  • Phone: 312-451-6418
  • Fax:
Mailing address:
  • Phone: 312-451-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: