MEDICARE: MRS. KEHINDE CHRISTIANA FAGBEMI 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	363L00000X	Nurse Practitioner	209018916	IL
2	367500000X	Certified Registered Nurse Anesthetist	209018916	IL

General Provider Information

NPI Number	:	1912465303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEHINDE CHRISTIANA FAGBEMI NP

Provider Business Mailing Address
First Line	:	516 E 45TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3421
Country	:	US
Telephone Number	:	708-662-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 E 45TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3421
Country	:	US
Telephone Number	:	708-662-0493
Fax Number	:

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

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	07/17/2024

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