Healthcare Provider Details

I. General information

NPI: 1982514865
Provider Name (Legal Business Name): OKECHUKWU NWANKWO APP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6039 W CERMAK RD
CICERO IL
60804-2021
US

IV. Provider business mailing address

14412 W RATHFARN DR
HOMER GLEN IL
60491-9400
US

V. Phone/Fax

Practice location:
  • Phone: 708-887-7502
  • Fax: 708-469-6445
Mailing address:
  • Phone: 773-867-9209
  • Fax: 708-469-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.036422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: