Provider Demographics
NPI:1639904246
Name:ILUFOYE, ANN (CRNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ILUFOYE
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3836
Mailing Address - Country:US
Mailing Address - Phone:215-474-4444
Mailing Address - Fax:
Practice Address - Street 1:5800 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3836
Practice Address - Country:US
Practice Address - Phone:215-474-4444
Practice Address - Fax:215-474-6021
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15128500207Q00000X
PASP030299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine