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General NPI Number Information
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NPI Number | 1922600873
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Entity Type | Individual
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Provider Name | OLUFUNKE GRACE AJIFOLOKUN
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Gender | Female
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Dates
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Enumeration Date | 11/14/2020
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 850 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60621-1902
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Country | US
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Telephone | 773-377-7304
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277.003940
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041427005
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 041427005
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209024875
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209024875
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License Number State | IL
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