Basic Information
| Provider Information | |||||||||
| NPI: | 1811585425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NWOKO | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | NGOZI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2081 CALISTOGA DR STE 2S | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604514833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154186070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2081 CALISTOGA DR STE 2S | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604514833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154186070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2021 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 209022585 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.