Provider Demographics
NPI:1174282826
Name:OMONIYI, IDAYATU OLA (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:IDAYATU
Middle Name:OLA
Last Name:OMONIYI
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:IDAYATU
Other - Middle Name:OLA
Other - Last Name:OMONIYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:7060 CENTENNIAL DR STE 102C
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1699
Mailing Address - Country:US
Mailing Address - Phone:708-575-8043
Mailing Address - Fax:708-575-8043
Practice Address - Street 1:444 N NORTHWEST HWY STE 202
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3271
Practice Address - Country:US
Practice Address - Phone:847-268-3176
Practice Address - Fax:833-464-4538
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024507163WP0808X
IL277003719364SP0808X
IL209024507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty