Healthcare Provider Details

I. General information

NPI: 1780402032
Provider Name (Legal Business Name): HABIBAT OWOLABI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N NAPER BLVD STE 200
NAPERVILLE IL
60563-8838
US

IV. Provider business mailing address

334 CLUBHOUSE ST
BOLINGBROOK IL
60490-2119
US

V. Phone/Fax

Practice location:
  • Phone: 312-731-3551
  • Fax: 207-888-1886
Mailing address:
  • Phone: 312-731-3551
  • Fax: 207-888-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.458344
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: