Healthcare Provider Details

I. General information

NPI: 1467295287
Provider Name (Legal Business Name): OLUYEMI ELIZABETH LASAKI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20855 S LAGRANGE RD STE 205
FRANKFORT IL
60423-2043
US

IV. Provider business mailing address

20855 S LAGRANGE RD STE 205
FRANKFORT IL
60423-2043
US

V. Phone/Fax

Practice location:
  • Phone: 773-985-3539
  • Fax: 773-825-8411
Mailing address:
  • Phone: 773-985-3539
  • Fax: 773-825-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.029884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: