=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073231890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AJ SYLVIE HEALTH SERVICES LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2022
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10522 S CICERO AVE
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-449-0400
-----------------------------------------------------
Fax | 773-688-0339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10522 S CICERO AVE
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-449-0400
-----------------------------------------------------
Fax | 773-373-0302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | ABIODUN J ATOMORI
-----------------------------------------------------
Credential | DNP, APRN-FPA
-----------------------------------------------------
Telephone | 773-879-0206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------