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General NPI Number Information
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NPI Number | 1588173165
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Entity Type | Individual
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Provider Name | AUGUSTINE U NWOKO
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Gender | Male
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 3030 FINLEY RD STE 140
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1179
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Country | US
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Telephone | 708-296-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 21258 LONGVIEW DR
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City | FRANKFORT
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State | IL
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Zip | 60423-8881
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Country | US
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Telephone | 708-296-5149
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.015254
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License Number State | IL
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