Healthcare Provider Details

I. General information

NPI: 1710606298
Provider Name (Legal Business Name): CHIBOGU VICTORIA OBIANWU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 05/12/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N. WESTMORELAND CANCER CENTER
LAKE FOREST IL
60045
US

IV. Provider business mailing address

1512 ARTAIUS PKWY STE 102
LIBERTYVILLE IL
60048-5231
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-6778
  • Fax:
Mailing address:
  • Phone: 847-847-2230
  • Fax: 833-464-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209025829
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number209025829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: