Healthcare Provider Details

I. General information

NPI: 1740600311
Provider Name (Legal Business Name): NDIDI OKANU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 W 87TH ST
CHICAGO IL
60652-3767
US

IV. Provider business mailing address

213 N RACINE AVE SUITE 100
CHICAGO IL
60607-1644
US

V. Phone/Fax

Practice location:
  • Phone: 773-776-4471
  • Fax: 773-564-3510
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011407
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR254241
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP50000385
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: