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General NPI Number Information
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NPI Number | 1003280090
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Entity Type | Individual
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Provider Name | MRS. MOPELOLA O FATUGA
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Gender | Female
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Dates
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Enumeration Date | 11/14/2015
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Last Update Date | 11/14/2015
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Provider Practice Location Address
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Address Line | 1005 HEATHROW CT
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City | WHEATON
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State | IL
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Zip | 60189-7774
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Country | US
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Telephone | 312-523-4742
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Fax | 630-752-0980
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Provider Business Mailing Address
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Address Line | 1005 HEATHROW CT
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City | WHEATON
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State | IL
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Zip | 60189-7774
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Country | US
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Telephone | 312-523-4742
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Fax | 630-752-0980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 3001137
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 400449
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 1011561
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License Number State | IL
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