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General NPI Number Information
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NPI Number | 1245844489
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Entity Type | Individual
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Provider Name | JOVITA ZALWANGO NASSOLO
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 116 1/2 N BENTON ST APT 2D
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City | WOODSTOCK
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State | IL
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Zip | 60098-3272
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Country | US
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Telephone | 815-245-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 116 1/2 N BENTON ST APT 2D
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City | WOODSTOCK
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State | IL
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Zip | 60098-3272
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Country | US
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Telephone | 815-245-8008
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209021920
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License Number State | IL
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