Healthcare Provider Details

I. General information

NPI: 1982143582
Provider Name (Legal Business Name): IJEOMA ANUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BURWASH AVE
SAVOY IL
61874-9510
US

IV. Provider business mailing address

206 BURWASH AVE
SAVOY IL
61874-9510
US

V. Phone/Fax

Practice location:
  • Phone: 217-356-3400
  • Fax: 217-866-0122
Mailing address:
  • Phone: 217-356-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209015479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: