Healthcare Provider Details

I. General information

NPI: 1245991397
Provider Name (Legal Business Name): OLUWATOSIN S IJALE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1073
US

IV. Provider business mailing address

20120 REDWOOD AVE
LYNWOOD IL
60411-6803
US

V. Phone/Fax

Practice location:
  • Phone: 773-690-9646
  • Fax:
Mailing address:
  • Phone: 773-690-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014290A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4034110
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1151586
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209027788
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10022850
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704425564
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041430715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: