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General NPI Number Information
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NPI Number | 1013482470
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Entity Type | Individual
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Provider Name | EVANS O OGEBOR RN
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Gender | Male
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 5159 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4931
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Country | US
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Telephone | 773-434-9216
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Fax | 773-434-2670
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Provider Business Mailing Address
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Address Line | 600 W FULTON ST STE 200
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City | CHICAGO
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State | IL
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Zip | 60661-1262
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Country | US
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Telephone | 312-526-2411
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Fax | 312-526-2329
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 041400854
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License Number State | IL
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