Provider Demographics
NPI:1154072817
Name:BANIRE, YEWANDE (FNP-C)
Entity type:Individual
Prefix:
First Name:YEWANDE
Middle Name:
Last Name:BANIRE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W222 LAFOX RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7625
Mailing Address - Country:US
Mailing Address - Phone:630-402-6627
Mailing Address - Fax:
Practice Address - Street 1:40W222 LAFOX RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7625
Practice Address - Country:US
Practice Address - Phone:312-646-8086
Practice Address - Fax:630-402-6683
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041414001163W00000X
IL029029249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse