Provider Demographics
NPI:1144094996
Name:AYOADE, YETUNDE A
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:A
Last Name:AYOADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YETUNDE
Other - Middle Name:
Other - Last Name:ALADEMOMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17901 GOVERNORS HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-960-4280
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS STATE HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-960-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily