Healthcare Provider Details

I. General information

NPI: 1396638672
Provider Name (Legal Business Name): JUSTINA NKECHINYERE ANAELE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E 93RD ST
CHICAGO IL
60617-3909
US

IV. Provider business mailing address

4133 W 80TH PL
CHICAGO IL
60652-2306
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-2000
  • Fax:
Mailing address:
  • Phone: 312-202-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: