Provider Demographics
NPI:1164028189
Name:KELANI, LATEEF (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:LATEEF
Middle Name:
Last Name:KELANI
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 WARRENVILLE RD STE 450-06
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1000
Mailing Address - Country:US
Mailing Address - Phone:567-262-4368
Mailing Address - Fax:
Practice Address - Street 1:3030 WARRENVILLE RD STE 450-06
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1000
Practice Address - Country:US
Practice Address - Phone:567-262-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002890363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health