Provider Demographics
NPI:1245991397
Name:IJALE, OLUWATOSIN S (FNP)
Entity type:Individual
Prefix:
First Name:OLUWATOSIN
Middle Name:S
Last Name:IJALE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20120 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-6803
Mailing Address - Country:US
Mailing Address - Phone:773-690-9646
Mailing Address - Fax:
Practice Address - Street 1:20303 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:773-690-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041430715163W00000X
IN71014290A363LF0000X
KY4034110363LF0000X
TX1151586363LF0000X
IL209027788363LF0000X
OR10022850363LF0000X
MI4704425564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse