Individual provider Active NPI

Ukachi O. Nwankpa, FNP

  • Family Nurse Practitioner
  • Matteson, IL
National Provider Identifier
1134776149
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.019716 Issued in IL
Practice address
1013 Warwick Dr
Matteson, IL 60443-1996
Phone
(773) 407-7814
Fax
(708) 980-2953
NPI assigned
Aug 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.019716 IL Primary

Addresses

Primary practice location

1013 Warwick Dr
Matteson, IL 60443-1996

Mailing address

1013 Warwick Dr
Matteson, IL 60443-1996
Phone (773) 407-7814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.019716ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Medical Services, LTD. CurrentSince Jan 1, 2020 Accepting new patients

Locations

1010 W 95th St
Chicago, IL 60643
Phone (312) 519-9009

2158 45th St
Highland, IN 46322
Phone (219) 554-0500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1134776149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 WARWICK DR",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431996",
            "telephone_number": "773-407-7814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 WARWICK DR",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431996",
            "telephone_number": "773-407-7814",
            "fax_number": "708-980-2953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWANKPA",
        "first_name": "UKACHI",
        "middle_name": "O.",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.019716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

Verify at the official NPI Registry.