MEDICARE: OLUYEMI ELIZABETH LASAKI PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.029884	IL

General Provider Information

NPI Number	:	1467295287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUYEMI ELIZABETH LASAKI PMHNP

Provider Business Mailing Address
First Line	:	20855 S LAGRANGE RD STE 205
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2043
Country	:	US
Telephone Number	:	773-985-3539
Fax Number	:	773-825-8411

Provider Business Practice Location Address
First Line	:	20855 S LAGRANGE RD STE 205
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2043
Country	:	US
Telephone Number	:	773-985-3539
Fax Number	:	773-825-8411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	01/27/2025

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