Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1033209267 |
---|---|
Provider Name | Mrs. Debra Ruth Onvejiaka |
First Address | Bolingbrook, IL 60440 |
Second Address | Bolingbrook, IL 60440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009920148 | BLUE CROSS BLUE SHIELD (01) | IL |
T38493 | (02) |