Innovative Advanced Practice Llc | |
4050 Healthway Dr Ste 140 Aurora IL 60504-8184 | |
(630) 549-5429 | |
(773) 912-6727 |
Full Name | Innovative Advanced Practice Llc |
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Speciality | Psychiatry & Neurology |
Location | 4050 Healthway Dr Ste 140, Aurora, Illinois |
Authorized Official Name and Position | Ednesha Ramey (CO-OWNER/NURSE PRACTITIONER) |
Authorized Official Contact | 6305495429 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Innovative Advanced Practice Llc 4050 Healthway Dr Ste 140 Aurora IL 60504-8184 Ph: (630) 549-5429 | Innovative Advanced Practice Llc 4050 Healthway Dr Ste 140 Aurora IL 60504-8184 Ph: (630) 549-5429 |
NPI Number | 1881361335 |
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Provider Enumeration Date | 08/24/2021 |
Last Update Date | 05/22/2023 |
Certification Date | 05/22/2023 |
Medicare PECOS PAC ID | 6901297316 |
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Medicare Enrollment ID | O20211220000376 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881361335 | NPI | - | NPPES |
1609354133 | Medicaid | IL |
Provider Name | Raymond Bryant |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609354133 PECOS PAC ID: 7911246996 Enrollment ID: I20190308002759 |
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