Provider Demographics
NPI:1528508678
Name:FADONUGBO-KUTON, JOAN OLUBUNMI (APN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:OLUBUNMI
Last Name:FADONUGBO-KUTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 W HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4407
Mailing Address - Country:US
Mailing Address - Phone:773-222-2570
Mailing Address - Fax:
Practice Address - Street 1:344 W HUBBARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4407
Practice Address - Country:US
Practice Address - Phone:773-222-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015710363LF0000X
IL209.015710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily