Provider Demographics
NPI:1306480025
Name:OGBOMEH, ONYEISI STEPHEN (DNP, APRN-FPA,FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ONYEISI
Middle Name:STEPHEN
Last Name:OGBOMEH
Suffix:
Gender:M
Credentials:DNP, APRN-FPA,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4600
Mailing Address - Country:US
Mailing Address - Phone:773-791-2317
Mailing Address - Fax:
Practice Address - Street 1:206 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-4600
Practice Address - Country:US
Practice Address - Phone:224-844-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily