Healthcare Provider Details

I. General information

NPI: 1720303993
Provider Name (Legal Business Name): OLATOKUNBO OLORUNFEMI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CENTRAL STREET
EVANSTON IL
60201-1150
US

IV. Provider business mailing address

3333 CENTRAL ST
EVANSTON IL
60201-1150
US

V. Phone/Fax

Practice location:
  • Phone: 773-764-9127
  • Fax:
Mailing address:
  • Phone: 773-764-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.007972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: