Provider Demographics
NPI:1306614664
Name:EVIE LIFE PSYCHIATRY LLC
Entity type:Organization
Organization Name:EVIE LIFE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:IMUENTIYAN
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:OYESIKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-439-8834
Mailing Address - Street 1:836 S SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4726
Mailing Address - Country:US
Mailing Address - Phone:312-779-6778
Mailing Address - Fax:
Practice Address - Street 1:340 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5069
Practice Address - Country:US
Practice Address - Phone:312-779-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)