Provider Demographics
NPI:1366066219
Name:EWANE, IVO EWANG (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:IVO
Middle Name:EWANG
Last Name:EWANE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-9229
Mailing Address - Country:US
Mailing Address - Phone:630-566-9165
Mailing Address - Fax:
Practice Address - Street 1:3116 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-9229
Practice Address - Country:US
Practice Address - Phone:630-566-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041745373163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health