Organization
BRIDGEWELL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISOKEN OGBOMO FNP (NURSE PRACTITIONER)
(312) 451-6418
Entity
Organization
Contact information
Practice address
402 W BOUGHTON RD STE A, BOLINGBROOK, IL 60440-1998
(312) 451-6148
Mailing address
402 W BOUGHTON RD STE A, BOLINGBROOK, IL 60440-1998
(312) 451-6148
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/31/2023
Last updated
09/01/2023
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