Healthcare Provider Details

I. General information

NPI: 1427929587
Provider Name (Legal Business Name): TEMISAN OKI-ODUNTAN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E MAIN ST STE 409
GALESBURG IL
61401-4867
US

IV. Provider business mailing address

311 E MAIN ST STE 409
GALESBURG IL
61401-4867
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-5880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.033223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: