Healthcare Provider Details

I. General information

NPI: 1386328524
Provider Name (Legal Business Name): GANIU JOKO AJAKAIYE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 N SHERIDAN RD STE 708
CHICAGO IL
60657-7227
US

IV. Provider business mailing address

2845 N SHERIDAN RD STE 708
CHICAGO IL
60657-7227
US

V. Phone/Fax

Practice location:
  • Phone: 773-649-4261
  • Fax:
Mailing address:
  • Phone: 773-649-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.027581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: