Healthcare Provider Details

I. General information

NPI: 1720849318
Provider Name (Legal Business Name): NICOLE OGUIKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 W DIVISION ST STE 508
CHICAGO IL
60651-3161
US

IV. Provider business mailing address

3190 BENNETT PL
AURORA IL
60502-7064
US

V. Phone/Fax

Practice location:
  • Phone: 773-364-4600
  • Fax:
Mailing address:
  • Phone: 630-450-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041444259
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209028667
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: