Healthcare Provider Details

I. General information

NPI: 1992037469
Provider Name (Legal Business Name): HABIBA SEIDU-FUSEINI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HABIBA B ABDALLAH

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 N NATCHEZ AVE
CHICAGO IL
60707-4023
US

IV. Provider business mailing address

722 N EMROY AVE
ELMHURST IL
60126-1710
US

V. Phone/Fax

Practice location:
  • Phone: 630-926-4225
  • Fax:
Mailing address:
  • Phone: 773-622-4313
  • Fax: 773-290-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041270674
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: