Provider Demographics
NPI:1427720234
Name:OTIENO-OBILO, GLORIA (NP)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:OTIENO-OBILO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:PAMELA
Other - Last Name:OTIENO-OBILO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:200 N LASALLE STREET
Mailing Address - Street 2:15550
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:888-660-4425
Mailing Address - Fax:
Practice Address - Street 1:200 N LASALLE STREET
Practice Address - Street 2:15550
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:888-660-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018136363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95018136OtherNP LICENCE