Provider Demographics
NPI:1902209232
Name:IRAULA, IVY-LOU VILLANUEVA (MSN, CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:IVY-LOU
Middle Name:VILLANUEVA
Last Name:IRAULA
Suffix:
Gender:F
Credentials:MSN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 14-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5966
Mailing Address - Country:US
Mailing Address - Phone:312-695-7382
Mailing Address - Fax:312-695-0014
Practice Address - Street 1:675 N SAINT CLAIR ST STE 14-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5966
Practice Address - Country:US
Practice Address - Phone:312-695-7382
Practice Address - Fax:312-695-0014
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011825363LX0001X
IL209011826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology