Provider Demographics
NPI:1699385088
Name:BENNETT, IVONA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:IVONA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:IVONA
Other - Middle Name:
Other - Last Name:ORUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 WILDSPRING PKWY
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8862
Mailing Address - Country:US
Mailing Address - Phone:815-955-0744
Mailing Address - Fax:
Practice Address - Street 1:219 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1442
Practice Address - Country:US
Practice Address - Phone:815-942-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021747363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner