Provider Demographics
NPI:1265065312
Name:OLOMADA, AFUSAT T (NP)
Entity type:Individual
Prefix:MRS
First Name:AFUSAT
Middle Name:T
Last Name:OLOMADA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 S CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2904
Mailing Address - Country:US
Mailing Address - Phone:773-544-0551
Mailing Address - Fax:
Practice Address - Street 1:8835 S CLYDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2904
Practice Address - Country:US
Practice Address - Phone:773-544-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
3299OtherCARE CODE