MEDICARE: INNOVATIVE ADVANCED PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208D00000X	General Practice Physician
2	261QH0100X	Health Service Clinic/Center
3	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881361335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE ADVANCED PRACTICE LLC

Provider Business Mailing Address
First Line	:	4050 HEALTHWAY DR STE 140
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8184
Country	:	US
Telephone Number	:	630-549-5429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 HEALTHWAY DR STE 140
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8184
Country	:	US
Telephone Number	:	630-549-5429
Fax Number	:	773-912-6727

Authorized Official
Title or Position	:	CO-OWNER/NURSE PRACTITIONER
Name	:	EDNESHA RAMEY
Credential	:	NP
Telephone Number	:	630-549-5429

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	05/22/2023

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