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Individual

MRS. DEHEDGRA IDOWU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGPCNP-BC

Contact information

Practice address
18 CHICAGO AVE, OAK PARK, IL 60302-2402
(773) 253-3933
(773) 437-6780
Mailing address
213 N RACINE AVE, CHICAGO, IL 60607-1644
(312) 733-9730

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN562570
PA
163WM0705X
Medical-Surgical Registered Nurse
041424181
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209012233
IL

Other

Enumeration date
02/09/2008
Last updated
10/15/2015
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