Provider Demographics
NPI:1710222716
Name:OYENUGA, AYODELE MOBOLANLE
Entity Type:Individual
Prefix:
First Name:AYODELE
Middle Name:MOBOLANLE
Last Name:OYENUGA
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 1:744 W BODE CIR APT 213
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2942
Mailing Address - Country:US
Mailing Address - Phone:631-889-4318
Mailing Address - Fax:
Practice Address - Street 1:744 W BODE CIR APT 213
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2942
Practice Address - Country:US
Practice Address - Phone:631-889-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043115890164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL043115890OtherIDFPR