Active NPI
Ememobong Sunday Udosen
- Primary Care Nurse Practitioner
- Lisle, IL
National Provider Identifier
1669291183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 209029110
- Practice address
- 550 Warrenville Rd
Lisle, IL 60532-4308 - Phone
- (855) 493-5523
- NPI assigned
- Oct 10, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 209029110 | IL | Primary |
Addresses
Primary practice location
550 Warrenville Rd
Lisle, IL 60532-4308
Mailing address
8340 Kolmar Ave
Skokie, IL 60076-2640
Phone (773) 425-9369
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250312000457 | IL | Order and Referring Only - Nurse Practitioner | 9739600313 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1669291183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8340 KOLMAR AVE",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600762640",
"telephone_number": "773-425-9369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 WARRENVILLE RD",
"city": "LISLE",
"state": "IL",
"postal_code": "605324308",
"telephone_number": "855-493-5523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UDOSEN",
"first_name": "EMEMOBONG",
"middle_name": "SUNDAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-10",
"last_updated": "2024-10-10",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "IL",
"license": "209029110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lisle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.