Healthcare Provider Details

I. General information

NPI: 1093162653
Provider Name (Legal Business Name): IMOLEAYO TAIWO BABARINDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IMOLEAYO OLUWAYEMISI SALAAM RN, BSN

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SAINT JOSEPH DR
BLOOMINGTON IL
61701-3636
US

IV. Provider business mailing address

5801 SEDGERMOOR DRIVE
WESTERVILLE OH
43081
US

V. Phone/Fax

Practice location:
  • Phone: 309-603-9800
  • Fax:
Mailing address:
  • Phone: 757-275-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209025775
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN399716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: