Provider Demographics
NPI:1891336020
Name:AVE, ADELWISA C
Entity Type:Individual
Prefix:MRS
First Name:ADELWISA
Middle Name:C
Last Name:AVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1529
Mailing Address - Country:US
Mailing Address - Phone:847-428-2273
Mailing Address - Fax:
Practice Address - Street 1:850 CENTRAL PKWY E STE 275
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5542
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019129363L00000X
TX1042845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner