Provider Demographics
NPI:1538960125
Name:ISHOLA AJAYI, MORUFAT (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MORUFAT
Middle Name:
Last Name:ISHOLA AJAYI
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20024 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1126
Mailing Address - Country:US
Mailing Address - Phone:708-574-6143
Mailing Address - Fax:
Practice Address - Street 1:5851 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2394
Practice Address - Country:US
Practice Address - Phone:708-574-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health