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1639743107 NPI number — OLADUNNI F BOLADALE

NPI Number: 1639743107
Health Care Provider/Practitioner: OLADUNNI F BOLADALE

Information about “1639743107” NPI (OLADUNNI F BOLADALE) exists in 1639743107 in HTML format HTML  |  1639743107 in plain Text format TXT  |  1639743107 in PDF (Portable Document Format) PDF  |  1639743107 in an XML format XML  formats.

NPI Number : 1639743107 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639743107",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOLADALE",
    "FirstName": "OLADUNNI",
    "MiddleName": "F",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "494 W BOUGHTON RD STE 2B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60440-1881",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "331-246-6564",
    "MailingAddressFaxNumber": "630-358-6841",
    "FirstLinePracticeLocationAddress": "494 W BOUGHTON RD STE 2B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOLINGBROOK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60440-1881",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "331-246-6564",
    "PracticeLocationAddressFaxNumber": "630-358-6841",
    "EnumerationDate": "05/18/2021",
    "LastUpdateDate": "10/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "277003428",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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