Healthcare Provider Details

I. General information

NPI: 1710446885
Provider Name (Legal Business Name): EUNICE OTUWA CROMWELL DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 W ADAMS ST
CHICAGO IL
60661-3509
US

IV. Provider business mailing address

6423 N DAMEN AVE APT 2E
CHICAGO IL
60645-5620
US

V. Phone/Fax

Practice location:
  • Phone: 312-382-8308
  • Fax:
Mailing address:
  • Phone: 773-526-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: