Provider Demographics
NPI:1114381191
Name:JIMONU, CHIJIOKE
Entity type:Individual
Prefix:
First Name:CHIJIOKE
Middle Name:
Last Name:JIMONU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16626 W 159TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8018
Mailing Address - Country:US
Mailing Address - Phone:815-834-9075
Mailing Address - Fax:815-834-9077
Practice Address - Street 1:16626 W 159TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8018
Practice Address - Country:US
Practice Address - Phone:815-834-9075
Practice Address - Fax:815-834-9077
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily