Provider Demographics
NPI:1407458540
Name:AGUDELO, JOWENA OPERANA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOWENA
Middle Name:OPERANA
Last Name:AGUDELO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JOWENA
Other - Middle Name:UGSAD
Other - Last Name:OPERANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6S 071 HYACINTH CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:312-451-8904
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:312-451-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041352555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse