Healthcare Provider Details

I. General information

NPI: 1619892007
Provider Name (Legal Business Name): CHANTELLE OGUNDELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28600 BELLA VISTA PKWY STE 2010A
WARRENVILLE IL
60555-1604
US

IV. Provider business mailing address

1356 WATERSIDE DR
BOLINGBROOK IL
60490-5436
US

V. Phone/Fax

Practice location:
  • Phone: 312-421-1016
  • Fax:
Mailing address:
  • Phone: 217-369-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041364155
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: