Provider Demographics
NPI:1609312859
Name:IGBA, ULOMA OKEKE (BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ULOMA
Middle Name:OKEKE
Last Name:IGBA
Suffix:
Gender:F
Credentials:BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 CLYDE AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-3010
Mailing Address - Country:US
Mailing Address - Phone:773-216-1914
Mailing Address - Fax:
Practice Address - Street 1:1243 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3709
Practice Address - Country:US
Practice Address - Phone:773-488-0844
Practice Address - Fax:773-994-4610
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily