Provider Demographics
NPI:1366921413
Name:NEWPORT, AILEEN (NP)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:NYONGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2467 W WEST BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-5428
Mailing Address - Country:US
Mailing Address - Phone:847-219-6948
Mailing Address - Fax:
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner