Provider Demographics
NPI:1659031201
Name:AKANDE, ABOSEDE OLUBUKOLA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ABOSEDE
Middle Name:OLUBUKOLA
Last Name:AKANDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 CATON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5624
Mailing Address - Country:US
Mailing Address - Phone:815-690-9067
Mailing Address - Fax:
Practice Address - Street 1:1813 CATON RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5624
Practice Address - Country:US
Practice Address - Phone:815-690-9067
Practice Address - Fax:779-435-5521
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043104748164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse