Provider Demographics
NPI:1669291183
Name:UDOSEN, EMEMOBONG SUNDAY
Entity type:Individual
Prefix:
First Name:EMEMOBONG
Middle Name:SUNDAY
Last Name:UDOSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 KOLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2640
Mailing Address - Country:US
Mailing Address - Phone:773-425-9369
Mailing Address - Fax:
Practice Address - Street 1:550 WARRENVILLE RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4308
Practice Address - Country:US
Practice Address - Phone:855-493-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029110363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care