Provider Demographics
NPI:1518717685
Name:AKOREDE, OLUWASEUN ASMAU
Entity Type:Individual
Prefix:MRS
First Name:OLUWASEUN
Middle Name:ASMAU
Last Name:AKOREDE
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 1:209 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:COWDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62422-1041
Mailing Address - Country:US
Mailing Address - Phone:217-783-6565
Mailing Address - Fax:
Practice Address - Street 1:209 E ELM ST
Practice Address - Street 2:
Practice Address - City:COWDEN
Practice Address - State:IL
Practice Address - Zip Code:62422-1041
Practice Address - Country:US
Practice Address - Phone:217-783-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner