Provider Demographics
NPI:1245615947
Name:OLUWAKOTANMI, GABRIEL (CNS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:OLUWAKOTANMI
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8056 SOUTH HARPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619
Mailing Address - Country:UM
Mailing Address - Phone:773-443-6307
Mailing Address - Fax:
Practice Address - Street 1:8056 S HARPER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4637
Practice Address - Country:US
Practice Address - Phone:773-443-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011501364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist