Provider Demographics
NPI:1093162653
Name:BABARINDE, IMOLEAYO TAIWO
Entity Type:Individual
Prefix:
First Name:IMOLEAYO
Middle Name:TAIWO
Last Name:BABARINDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IMOLEAYO
Other - Middle Name:OLUWAYEMISI
Other - Last Name:SALAAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:5801 SEDGERMOOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:757-275-5729
Mailing Address - Fax:
Practice Address - Street 1:210 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3636
Practice Address - Country:US
Practice Address - Phone:309-603-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN399716163W00000X
IL209025775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse