Basic Information
| Provider Information | |||||||||
| NPI: | 1609412410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAPOHUNDA | ||||||||
| FirstName: | OLALEKAN | ||||||||
| MiddleName: | MOSES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 159TH ST | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087989475 | ||||||||
| FaxNumber: | 7087989485 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 159TH ST | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084293300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2019 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041.433033 | IL | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 209.023658 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.