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

Samson Ajibola Omowumi

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1457181877

Samson Ajibola Omowumi is a Psychiatric/Mental Health Nurse Practitioner in Peoria, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2024

Practice location Address checks out

5401 N Knoxville Ave
Peoria, IL 61614-5098
Phone: (614) 816-7589
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 209.030167 (IL)

Record details

NPI number1457181877
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 2, 2024
Last updated in NPPESAugust 2, 2024
Certification dateAugust 2, 2024

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