Provider Demographics
NPI:1174282826
Name:OMONIYI, IDAYATU OLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:IDAYATU
Middle Name:OLA
Last Name:OMONIYI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:IDAYATU
Other - Middle Name:OLA
Other - Last Name:OMONIYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:444 N NORTHWEST HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3271
Mailing Address - Country:US
Mailing Address - Phone:847-766-0952
Mailing Address - Fax:833-464-4538
Practice Address - Street 1:444 N NORTHWEST HWY STE 202
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3271
Practice Address - Country:US
Practice Address - Phone:847-268-3176
Practice Address - Fax:833-464-4538
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024507363LP0808X
IL209.024507163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health