MEDICARE: MRS. CECILIA CHIDINMA ISIOMA NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.029574	IL

General Provider Information

NPI Number	:	1568217354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CECILIA CHIDINMA ISIOMA NP

Provider Business Mailing Address
First Line	:	PO BOX 806112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-4122
Country	:	US
Telephone Number	:	312-489-0103
Fax Number	:	872-266-0204

Provider Business Practice Location Address
First Line	:	1750 E 87TH ST STE 109
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2706
Country	:	US
Telephone Number	:	312-489-0103
Fax Number	:	872-266-0204

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

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	02/17/2026

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