Healthcare Provider Details

I. General information

NPI: 1659757888
Provider Name (Legal Business Name): YVONNE OLDAKER CNM/APRN-FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19831 GOVERNORS HWY
FLOSSMOOR IL
60422-2001
US

IV. Provider business mailing address

PO BOX 1584
HOMEWOOD IL
60430-0584
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277003181
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: