Healthcare Provider Details

I. General information

NPI: 1619442084
Provider Name (Legal Business Name): MICHELLE OLASIMBO APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 HOWARD ST
EVANSTON IL
60202-3735
US

IV. Provider business mailing address

1224 W JARVIS AVE APT 3S
CHICAGO IL
60626-2037
US

V. Phone/Fax

Practice location:
  • Phone: 224-307-8550
  • Fax: 847-491-0380
Mailing address:
  • Phone: 773-540-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: