Provider Demographics
NPI:1275301798
Name:OLANIBA-ADEBISI, SAFURAT T
Entity Type:Individual
Prefix:MS
First Name:SAFURAT
Middle Name:T
Last Name:OLANIBA-ADEBISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 N CLAREMONT AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1882
Mailing Address - Country:US
Mailing Address - Phone:773-330-7675
Mailing Address - Fax:
Practice Address - Street 1:7200 N CLAREMONT AVE APT 403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1882
Practice Address - Country:US
Practice Address - Phone:773-330-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-028959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health