Provider Demographics
NPI:1346602265
Name:BABALOLA, ADESOLA O (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:O
Last Name:BABALOLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ADESOLA
Other - Middle Name:O
Other - Last Name:OKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:966 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2355 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3837
Practice Address - Country:US
Practice Address - Phone:773-254-1400
Practice Address - Fax:312-829-6375
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily