Provider Demographics
NPI:1275197311
Name:NNABUEZE, BRENDA (APN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NNABUEZE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:ONUSELOGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20557 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-8572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11401 S OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4196
Practice Address - Country:US
Practice Address - Phone:773-233-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily