Healthcare Provider Details

I. General information

NPI: 1821582115
Provider Name (Legal Business Name): AJAA OLIVER MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N WARWICK AVE
WESTMONT IL
60559-1550
US

IV. Provider business mailing address

926 MAPLE AVE APT 329
DOWNERS GROVE IL
60515-7402
US

V. Phone/Fax

Practice location:
  • Phone: 630-828-6944
  • Fax:
Mailing address:
  • Phone: 763-486-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.034524
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2462101
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: