Healthcare Provider Details

I. General information

NPI: 1952879777
Provider Name (Legal Business Name): FOLARIN OPAKUNLE DNP, FNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 S PARK AVE STE 103A
SOUTH HOLLAND IL
60473-1379
US

IV. Provider business mailing address

15525 S PARK AVE STE 103A
SOUTH HOLLAND IL
60473-1379
US

V. Phone/Fax

Practice location:
  • Phone: 708-466-9351
  • Fax: 708-331-4216
Mailing address:
  • Phone: 708-466-9351
  • Fax: 708-331-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041337696
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number041337696
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: