Healthcare Provider Details

I. General information

NPI: 1457129272
Provider Name (Legal Business Name): NNEKA IFEOMA OKAGBUE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5736 W NORTH AVE
CHICAGO IL
60639-4152
US

IV. Provider business mailing address

7343 MARSHALL AVE
HAMMOND IN
46323-2653
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-9850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: