Provider Demographics
NPI:1336899236
Name:OBODOAKOR, ADAKU JULIET (NP)
Entity Type:Individual
Prefix:MISS
First Name:ADAKU
Middle Name:JULIET
Last Name:OBODOAKOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 PEBBLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2151
Mailing Address - Country:US
Mailing Address - Phone:708-620-9562
Mailing Address - Fax:
Practice Address - Street 1:17700 PEBBLEWOOD LN
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2151
Practice Address - Country:US
Practice Address - Phone:708-620-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily