MEDICARE: SOLOMON NJUBA

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	163W00000X	Registered Nurse	041370278	IL
2	367500000X	Certified Registered Nurse Anesthetist	209.023544	IL

General Provider Information

NPI Number	:	1427631225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOLOMON NJUBA

Provider Business Mailing Address
First Line	:	3613 S WINCHESTER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1234
Country	:	US
Telephone Number	:	773-319-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 S WINCHESTER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1234
Country	:	US
Telephone Number	:	773-319-7985
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/21/2022

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Directions to “ SOLOMON NJUBA ” Practice Location

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