Provider Demographics
NPI:1922542034
Name:IDJESA, UFUOMA CHINENYE SR
Entity Type:Individual
Prefix:MISS
First Name:UFUOMA
Middle Name:CHINENYE
Last Name:IDJESA
Suffix:SR
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:UFUOMA
Other - Middle Name:CHINENEYE
Other - Last Name:IDJESA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1441 W FARWELL AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6900
Mailing Address - Country:US
Mailing Address - Phone:847-276-6658
Mailing Address - Fax:
Practice Address - Street 1:1010 N HOOKER ST STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4633
Practice Address - Country:US
Practice Address - Phone:312-943-3600
Practice Address - Fax:312-943-3096
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041393914163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health