Oreoluwatomi Agbaje, NURSE PRACTITIONER
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Chicago, IL
NPI 1700599248 · NPPES record last updated Dec 29, 2022
Key facts
- NPI
- 1700599248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 209026038 (IL)
- Practice address
- 2707 N Halsted St Ste 1
Chicago, IL 60614-0877 - Phone
- (773) 699-4924
- NPI assigned
- Dec 29, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230427002893 | IL | Practitioner - Nurse Practitioner | 2365807252 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209026038 | IL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elemental Center LTD. | Current |
Accepting new patients | |
| Onward Nursing Healthcare LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Grow Healthcare Group PA | Psychiatric/Mental Health | Current |
Accepting new patients |
| Martins Adeoye, LLC | Past |
Accepting new patients |
Locations
5025 N Paulina St
Ste 435
Chicago, IL 60640
Phone (217) 385-0565
2707 N Halsted St
Ste 1
Chicago, IL 60614
Phone (773) 699-4924
605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338
1323 Butterfield Rd
Ste 116
Downers Grove, IL 60515
Phone (331) 330-9955
14484 John Humphrey Dr
Orland Park, IL 60462
Phone (708) 741-2325
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 209026038 | IL | Yes |
Addresses
Primary practice location
2707 N Halsted St Ste 1
Chicago, IL 60614-0877
Mailing address
2707 N Halsted St Ste 1
Chicago, IL 60614-0877
Phone (773) 699-4924
Other providers in Chicago, IL
- Luke William Agase
- Agate Psychotherapy
- Taylor N Agate
- Agave Studio for Psychotherapy and Spiritual Direction
- Agave Studio, LLC
- Prince Amechi Agbakahi
- Aira Louise Padua Agbayani
- Theodore Lord Agbemaple
- Chinwike T Agbo
- Alisha Agbonghae
All providers in Chicago, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.