Provider Demographics
NPI:1366985798
Name:OMOYENI, FOLUKE IBIYEMI (NP)
Entity type:Individual
Prefix:MRS
First Name:FOLUKE
Middle Name:IBIYEMI
Last Name:OMOYENI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26605 LINDENGATE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5878
Mailing Address - Country:US
Mailing Address - Phone:773-510-6687
Mailing Address - Fax:
Practice Address - Street 1:26605 LINDENGATE CIR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5878
Practice Address - Country:US
Practice Address - Phone:773-510-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015199363LF0000X
IL209015199363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily