Provider Demographics
NPI:1467919498
Name:IVY, SHERANN (APRN-FPA)
Entity Type:Individual
Prefix:MS
First Name:SHERANN
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:APRN-FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4233
Mailing Address - Country:US
Mailing Address - Phone:312-285-2982
Mailing Address - Fax:844-835-7034
Practice Address - Street 1:2259 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4233
Practice Address - Country:US
Practice Address - Phone:312-285-2982
Practice Address - Fax:844-835-7034
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001228363LP0808X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467919498OtherINSURANCE
IL1467919498Medicaid