Healthcare Provider Details

I. General information

NPI: 1023944030
Provider Name (Legal Business Name): OLAMIDOYIN PHEBIAN OLUFADE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE STE 100
AURORA IL
60506-1459
US

IV. Provider business mailing address

1315 N HIGHLAND AVE STE 100
AURORA IL
60506-1459
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.035791
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: