Provider Demographics
NPI:1679108153
Name:OLADIPO, JAMILA MONINUOLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:MONINUOLA
Last Name:OLADIPO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W AUGUSTA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4327
Mailing Address - Country:US
Mailing Address - Phone:773-248-2255
Mailing Address - Fax:773-304-4143
Practice Address - Street 1:700 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2323
Practice Address - Country:US
Practice Address - Phone:773-355-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020935363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health