Healthcare Provider Details

I. General information

NPI: 1982177473
Provider Name (Legal Business Name): CAROLINE EBOT ENOH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 MC DUFFEE CIR
NORTH AURORA IL
60542-2027
US

IV. Provider business mailing address

12040 RAYMOND CT
HUNTLEY IL
60142-8069
US

V. Phone/Fax

Practice location:
  • Phone: 630-906-1874
  • Fax:
Mailing address:
  • Phone: 847-515-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017332
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: