Healthcare Provider Details

I. General information

NPI: 1356772743
Provider Name (Legal Business Name): HELEN NKEM UTOMI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209010643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: