Individual
INNOCENTCIA WAGALA-AYAFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1776 CAMDEN DR, GLENVIEW, IL 60025-7616
(847) 832-9821
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1718
(847) 570-4710
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-002320
IL
Other
Enumeration date
11/18/2011
Last updated
02/13/2012
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