Provider Demographics
NPI:1578232468
Name:AVERY INTEGRATIVE WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:AVERY INTEGRATIVE WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNM, WHNP
Authorized Official - Phone:708-203-7455
Mailing Address - Street 1:16325 HARLEM AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1688
Mailing Address - Country:US
Mailing Address - Phone:708-203-7455
Mailing Address - Fax:708-556-2316
Practice Address - Street 1:16325 HARLEM AVE STE 260
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1688
Practice Address - Country:US
Practice Address - Phone:708-203-7455
Practice Address - Fax:708-556-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008339Medicaid