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General NPI Number Information
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NPI Number | 1750552931
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Entity Type | Individual
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Provider Name | OLUBUSAYO AIFESEHI APN-C, DNP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 1701 W SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60622-5646
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Country | US
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Telephone | 973-715-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 15 17TH AVE
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City | NEWARK
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State | NJ
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Zip | 07103-2961
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Country | US
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Telephone | 973-715-8871
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Fax |
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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 | 209020246
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License Number State | IL
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