Healthcare Provider Details

I. General information

NPI: 1053787630
Provider Name (Legal Business Name): AIMEE LYNN NALEWAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE AMBROSE PA

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST
ADDISON IL
60101-2586
US

IV. Provider business mailing address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3645
  • Fax:
Mailing address:
  • Phone: 630-938-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: