Provider Demographics
NPI:1497458145
Name:ABEGUNDE, OLASUMBO OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OLASUMBO
Middle Name:OLUBUNMI
Last Name:ABEGUNDE
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 1:2346 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-6000
Mailing Address - Country:US
Mailing Address - Phone:331-301-8925
Mailing Address - Fax:
Practice Address - Street 1:2346 UPLAND RD
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-6000
Practice Address - Country:US
Practice Address - Phone:331-301-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.517591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse