Provider Demographics
NPI:1275049694
Name:OGBOMO, ISOKEN FRANCA (FNP)
Entity Type:Individual
Prefix:
First Name:ISOKEN
Middle Name:FRANCA
Last Name:OGBOMO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BOUGHTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1998
Mailing Address - Country:US
Mailing Address - Phone:312-451-6418
Mailing Address - Fax:
Practice Address - Street 1:1522 SCHAFER AVE
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-3230
Practice Address - Country:US
Practice Address - Phone:312-451-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily