Healthcare Provider Details

I. General information

NPI: 1619852464
Provider Name (Legal Business Name): CHIKA MUOGHALU DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SOUTHWICK DR STE 630K
MATTESON IL
60443-2254
US

IV. Provider business mailing address

1724 BAYBROOK LN
NAPERVILLE IL
60564-6173
US

V. Phone/Fax

Practice location:
  • Phone: 312-800-0791
  • Fax: 866-439-2402
Mailing address:
  • Phone: 630-404-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033962
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209033962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: