Provider Demographics
NPI:1629098009
Name:ADEBAYO, OLUYEMISI OLUDOYIN (APN/CNM/NP)
Entity Type:Individual
Prefix:MS
First Name:OLUYEMISI
Middle Name:OLUDOYIN
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:APN/CNM/NP
Other - Prefix:DR
Other - First Name:OLUYEMISI
Other - Middle Name:OLUDOYIN
Other - Last Name:ADEBAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN/NP-C
Mailing Address - Street 1:101 ILIAD DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4840
Mailing Address - Country:US
Mailing Address - Phone:708-704-0847
Mailing Address - Fax:
Practice Address - Street 1:101 ILIAD DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4840
Practice Address - Country:US
Practice Address - Phone:708-704-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004866367A00000X
IL209.014165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife