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General NPI Number Information
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NPI Number | 1962007880
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Entity Type | Individual
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Provider Name | SABITIYU K FOLAWIYO-SABA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 700 W LINCOLN ST
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City | PONTIAC
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State | IL
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Zip | 61764-2323
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Country | US
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Telephone | 815-842-2816
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Fax |
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Provider Business Mailing Address
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Address Line | 2653 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1647
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Country | US
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Telephone | 773-257-6672
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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 | 209022450
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License Number State | IL
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