Provider Demographics
NPI:1376346999
Name:OLAIFA, FELICIA ABOSEDE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:ABOSEDE
Last Name:OLAIFA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20048 PRESTON LN
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-8663
Mailing Address - Country:US
Mailing Address - Phone:708-270-9303
Mailing Address - Fax:
Practice Address - Street 1:20048 PRESTON LN
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-8663
Practice Address - Country:US
Practice Address - Phone:708-270-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health