Healthcare Provider Details

I. General information

NPI: 1598103459
Provider Name (Legal Business Name): ADEOLA L ADEOYE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

675 N SAINT CLAIR ST
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8143
  • Fax:
Mailing address:
  • Phone: 312-695-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209010412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: