Healthcare Provider Details

I. General information

NPI: 1023845203
Provider Name (Legal Business Name): IVAN ARYEE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST STE 4141
EAST CHICAGO IN
46312-3052
US

IV. Provider business mailing address

750 OAKMONT LN
WESTMONT IL
60559-5551
US

V. Phone/Fax

Practice location:
  • Phone: 219-392-7466
  • Fax: 219-392-7470
Mailing address:
  • Phone: 877-492-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71016124A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number231220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: