Provider Demographics
NPI:1427415207
Name:ADEKUNLE, IDAYAT ADEOLA (FNP)
Entity Type:Individual
Prefix:
First Name:IDAYAT
Middle Name:ADEOLA
Last Name:ADEKUNLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 N MILWAUKEE AVE
Mailing Address - Street 2:APT. 609
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4098
Mailing Address - Country:US
Mailing Address - Phone:773-370-1539
Mailing Address - Fax:
Practice Address - Street 1:1165 N MILWAUKEE AVE
Practice Address - Street 2:APT. 609
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4098
Practice Address - Country:US
Practice Address - Phone:773-370-1539
Practice Address - Fax:773-377-6188
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily