MEDICARE: MS. NGOZI V UBAGHARA APRN

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	277002068	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277002068	IL

General Provider Information

NPI Number	:	1821583899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NGOZI V UBAGHARA APRN

Provider Business Mailing Address
First Line	:	960 N WASHINGTON AVE
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2006
Country	:	US
Telephone Number	:	708-262-2484
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 N WASHINGTON AVE
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2006
Country	:	US
Telephone Number	:	708-262-2484
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	09/01/2023

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