Provider Demographics
NPI:1578805503
Name:IVANOVA, IVELINA TONCHEVA (APN, FNP)
Entity Type:Individual
Prefix:MS
First Name:IVELINA
Middle Name:TONCHEVA
Last Name:IVANOVA
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-486-2700
Mailing Address - Fax:708-486-2702
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-486-2700
Practice Address - Fax:708-486-2702
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily