Provider Demographics
NPI:1013121177
Name:HARVEY, ANN M (APN, CNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:HARVEY
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:HARVEY
Other - Last Name:SPEVACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CNP, DNP
Mailing Address - Street 1:900 S FRONTAGE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4903
Mailing Address - Country:US
Mailing Address - Phone:773-564-6060
Mailing Address - Fax:773-564-6061
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-296-3646
Practice Address - Fax:773-296-7289
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-215814163W00000X
IL209002533363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1316998578OtherGROUP PRACTICE NPI
ILP87977Medicare UPIN