Provider Demographics
NPI:1780402032
Name:OWOLABI, HABIBAT (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HABIBAT
Middle Name:
Last Name:OWOLABI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 CLUBHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2119
Mailing Address - Country:US
Mailing Address - Phone:312-731-3551
Mailing Address - Fax:
Practice Address - Street 1:334 CLUBHOUSE ST
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-2119
Practice Address - Country:US
Practice Address - Phone:312-731-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.458344163W00000X
IL209.032808363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse