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General NPI Number Information
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NPI Number | 1174282826
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Entity Type | Individual
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Provider Name | IDAYATU OLA OMONIYI APRN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 7060 CENTENNIAL DR STE 102B
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City | TINLEY PARK
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State | IL
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Zip | 60477-1699
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Country | US
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Telephone | 708-575-8043
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Fax | 708-575-7872
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Provider Business Mailing Address
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Address Line | 7060 CENTENNIAL DR STE 102B
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City | TINLEY PARK
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State | IL
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Zip | 60477-1699
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Country | US
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Telephone | 708-575-8043
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Fax | 708-575-7872
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209024507
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 209.024507
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 277003719
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License Number State | IL
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