Individual
MR. OGHENERO LUCKY OLOMUKORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
4 MEMORIAL DR STE 210, ALTON, IL 62002-6704
(618) 465-8829
(618) 465-5499
Mailing address
4 MEMORIAL DR STE 210, ALTON, IL 62002-6704
(618) 465-8829
(618) 465-5499
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209025704
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2022
Last updated
10/12/2022
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