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General NPI Number Information
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NPI Number | 1659220069
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Entity Type | Individual
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Provider Name | BONAVENTURE I OGU
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Gender | Male
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 4554 N BROADWAY ST STE 218
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City | CHICAGO
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State | IL
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Zip | 60640-5671
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Country | US
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Telephone | 773-554-2490
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 LEE ST
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City | EVANSTON
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State | IL
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Zip | 60202-1537
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Country | US
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Telephone |
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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 | 2025086017
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License Number State | IL
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