Provider Demographics
NPI:1922841758
Name:JAIYEOBA, JOSEPH O (N/A)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:O
Last Name:JAIYEOBA
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GRACELAND AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4574
Mailing Address - Country:US
Mailing Address - Phone:646-369-7202
Mailing Address - Fax:
Practice Address - Street 1:700 GRACELAND AVE APT 603
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4574
Practice Address - Country:US
Practice Address - Phone:646-369-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide