Healthcare Provider Details

I. General information

NPI: 1700102647
Provider Name (Legal Business Name): CHINYERE OKOROH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 N OAKLAWN AVE SUITE 104
ELMHURST IL
60126-1045
US

IV. Provider business mailing address

15629 DREXEL AVE
DOLTON IL
60419-2751
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax: 630-832-3078
Mailing address:
  • Phone: 708-261-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.007787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: