Individual
MOFOLUWA AMIYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4512 JEFFERSON DR, RICHTON PARK, IL 60471-1852
(708) 244-7449
Mailing address
4512 JEFFERSON DR, RICHTON PARK, IL 60471-1852
(708) 244-7449
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213401409214100
—
IL
Enumeration date
03/10/2014
Last updated
02/25/2019
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