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NPI Code Detail

MEDICARE: GRACE NGOZI ENEOGWE NURSE PRACTITIONER

MEDICARE: GRACE NGOZI ENEOGWE NURSE PRACTITIONER
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
1363LP2300XPrimary Care Nurse Practitioner209007655IL
2363LF0000XFamily Nurse Practitioner209007655IL

General Provider Information

NPI Number : 1467684332
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE NGOZI ENEOGWE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 795 CITADEL CT
Second Line :
City : DES PLAINES
State : IL
Zip : 60016-6489
Country : US
Telephone Number : 847-635-8142
Fax Number :
Provider Business Practice Location Address
First Line : 1901 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3714
Country : US
Telephone Number : 312-864-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2009
Last Update Date : 03/07/2024

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Directions to “ GRACE NGOZI ENEOGWE NURSE PRACTITIONER” Practice Location

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