| Doctor Name: | MRS. NWADIUTOR O IFEZUE |
| NPI Number: | 1205247244 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 041290058 |
| Business Practice Address: | 22621 Lakeshore Dr Richton Park, IL - 604711612 |
| Business Phone Number: | 7089451712 |
| Business Fax Number: | |
| Mailing Address: | 1750 E 87th St, Ste 109 CHICAGO |
| State: | IL |
| Postal Code: | 606172706 |
| Phone Number: | 7739339300 |
| Fax Number: | 7739339301 |
| NPI Enumeration Date: | 05/13/2014 |
| NPI Last Update Date: | 03/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 041290058 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |