Provider Demographics
NPI:1831952258
Name:OMOFONMWAN, ELIZABETH O
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:OMOFONMWAN
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 1:5 ROSE HILL CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6405
Mailing Address - Country:US
Mailing Address - Phone:224-375-0455
Mailing Address - Fax:
Practice Address - Street 1:5 ROSE HILL CT
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6405
Practice Address - Country:US
Practice Address - Phone:224-375-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker