Provider Demographics
NPI:1801520630
Name:ABIMBOLA AKINOLA, RUBABETU
Entity type:Individual
Prefix:MRS
First Name:RUBABETU
Middle Name:
Last Name:ABIMBOLA AKINOLA
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 1:75 EXECUTIVE DR STE 339
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8124
Mailing Address - Country:US
Mailing Address - Phone:312-973-2554
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR STE 339
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8124
Practice Address - Country:US
Practice Address - Phone:312-973-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309019254363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program