Healthcare Provider Details

I. General information

NPI: 1376287680
Provider Name (Legal Business Name): WUNMI F OLOKUN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 FOREST VIEW LN
LANSING IL
60438-4513
US

IV. Provider business mailing address

18765 FOREST VIEW LN
LANSING IL
60438-4513
US

V. Phone/Fax

Practice location:
  • Phone: 708-539-3292
  • Fax:
Mailing address:
  • Phone: 708-539-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04220399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: