Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209-006082 | IL |
NPI | 1023027869 |
---|---|
Provider Name | Dolly Osas Agba |
First Address | Joliet, IL 60431-9307 |
Second Address | Joliet, IL 60433-2548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |