Provider Demographics
NPI:1861908006
Name:EVULUKWU, STELLA NKECHINYERE (RN MSN FNP-BC CCRN)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:NKECHINYERE
Last Name:EVULUKWU
Suffix:
Gender:F
Credentials:RN MSN FNP-BC CCRN
Other - Prefix:MISS
Other - First Name:STELLA
Other - Middle Name:NKECHINYERE
Other - Last Name:OKORIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17034 CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3742
Mailing Address - Country:US
Mailing Address - Phone:708-455-2014
Mailing Address - Fax:
Practice Address - Street 1:17034 CLYDE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3742
Practice Address - Country:US
Practice Address - Phone:708-455-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner