Provider Demographics
NPI:1952879777
Name:OPAKUNLE, FOLARIN (FNP)
Entity Type:Individual
Prefix:
First Name:FOLARIN
Middle Name:
Last Name:OPAKUNLE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 S PARK AVE STE 103A
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1379
Mailing Address - Country:US
Mailing Address - Phone:708-466-9351
Mailing Address - Fax:708-331-4216
Practice Address - Street 1:15525 S PARK AVE STE 103A
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1379
Practice Address - Country:US
Practice Address - Phone:708-466-9351
Practice Address - Fax:708-331-4216
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily