Healthcare Provider Details

I. General information

NPI: 1073388104
Provider Name (Legal Business Name): ADEWELL HOLISTIC HEALTH & MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 HICKS RD STE D
ROLLING MEADOWS IL
60008-1247
US

IV. Provider business mailing address

1833 HICKS RD STE D
ROLLING MEADOWS IL
60008-1247
US

V. Phone/Fax

Practice location:
  • Phone: 847-610-9400
  • Fax: 847-572-2170
Mailing address:
  • Phone: 847-610-9400
  • Fax: 847-572-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ADERONKE OSHIBAJO
Title or Position: FNP-C, PMHNP-BC
Credential: APN
Phone: 847-610-9400