Provider Demographics
NPI:1659909406
Name:OYEWOLE, MUDIRA TEMILOLA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MUDIRA
Middle Name:TEMILOLA
Last Name:OYEWOLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:MUDIRA
Other - Middle Name:TEMILOLA
Other - Last Name:OYEWOLE-KELANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:493 LESLIE CT
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8818
Mailing Address - Country:US
Mailing Address - Phone:773-742-8726
Mailing Address - Fax:
Practice Address - Street 1:493 LESLIE CT
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8818
Practice Address - Country:US
Practice Address - Phone:773-742-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health