Healthcare Provider Details

I. General information

NPI: 1497660484
Provider Name (Legal Business Name): OLUBUNMI ADEBOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20128 DRIFTWOOD AVE
LYNWOOD IL
60411-6811
US

IV. Provider business mailing address

20128 DRIFTWOOD AVE
LYNWOOD IL
60411-6811
US

V. Phone/Fax

Practice location:
  • Phone: 708-845-0501
  • Fax:
Mailing address:
  • Phone: 708-845-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.034903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: