Provider Demographics
NPI:1801615117
Name:BABATUNDE-AINA, OLAMIDE
Entity type:Individual
Prefix:MRS
First Name:OLAMIDE
Middle Name:
Last Name:BABATUNDE-AINA
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 1:4401 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:391 E MADISON STREET
Practice Address - Street 2:4G
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701
Practice Address - Country:US
Practice Address - Phone:440-600-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner