Provider Demographics
NPI:1760918403
Name:AKOREDE, NIMAT
Entity Type:Individual
Prefix:
First Name:NIMAT
Middle Name:
Last Name:AKOREDE
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 1:3575 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3774
Mailing Address - Country:US
Mailing Address - Phone:224-277-1645
Mailing Address - Fax:847-603-1921
Practice Address - Street 1:18698 W PETERSON RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1052
Practice Address - Country:US
Practice Address - Phone:847-377-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041402048163W00000X
IL209020588363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse