Individual
GRACE NWAKA WABOMNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
17 E GRANDVIEW DR, SOUTH HOLLAND, IL 60473-1099
(708) 439-5003
Mailing address
17 E GRANDVIEW DR, SOUTH HOLLAND, IL 60473-1099
(708) 439-5003
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209018727
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209018727
ILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
02/01/2019
Last updated
05/04/2026
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