Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Bantale Oluremi Ayisire

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1538969282

Dr. Bantale Oluremi Ayisire is a Nurse Practitioner in Winnetka, California. Qualified in 2024, 2 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2025

Practice location Address checks out

20623 Green Ash Ln
Winnetka, CA 91306-1557
Phone: (253) 300-1864
Fax: (818) 303-3331
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95033816 (CA)

Record details

NPI number1538969282
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 13, 2025
Last updated in NPPESMarch 25, 2026
Certification dateMarch 25, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Winnetka