MEDICARE: UNYIME EKANEM FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209026890	IL

General Provider Information

NPI Number	:	1043912843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNYIME EKANEM FNP

Provider Business Mailing Address
First Line	:	9915 HUNTERS RUN
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9262
Country	:	US
Telephone Number	:	618-203-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	9915 HUNTERS RUN
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9262
Country	:	US
Telephone Number	:	618-203-2217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	09/27/2023

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Directions to “ UNYIME EKANEM FNP” Practice Location

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