Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209009857 | IL |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 277000226 | IL |
NPI | 1033555388 |
---|---|
Provider Name | Dr. Victoria O. Fadiya |
First Address | Mokena, IL 60448-7400 |
Second Address | Mokena, IL 60448-7400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 16/10/2021 |