Healthcare Provider Details

I. General information

NPI: 1750903159
Provider Name (Legal Business Name): UGONWA GLORIA IZUEGBU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 S EWING AVE
CHICAGO IL
60617-6220
US

IV. Provider business mailing address

10551 S EWING AVE
CHICAGO IL
60617-6220
US

V. Phone/Fax

Practice location:
  • Phone: 630-215-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277004506
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: