NPIMap

Organization Active NPI

Ivory Wellness PLLC

  • Clinic/Center
  • River Forest, IL
National Provider Identifier
1003640319
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
IVORY WELLNESS PLLC
Practice address
400 Lathrop Ave Ste 95
River Forest, IL 60305-1869
Phone
(708) 724-9255
NPI assigned
Aug 28, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Przybyla, FNP-BCNPI 1316341209
Title
Ownder
Phone
(708) 790-1952

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Health Service Clinic/Center 261QH0100X

Addresses

Primary practice location

400 Lathrop Ave Ste 95
River Forest, IL 60305-1869

Mailing address

400 Lathrop Ave Ste 95
River Forest, IL 60305-1869
Phone (708) 724-9255

Other names 2

  • Ivory Wellness Other name
  • Ivory Wellness & Aesthetics Other name

National Provider Directory

National Provider Directory

Locations

400 Lathrop Ave
Ste 95
River Forest, IL 60305
Phone (708) 724-9255

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1003640319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LATHROP AVE STE 95",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051869",
            "telephone_number": "708-724-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LATHROP AVE STE 95",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051869",
            "telephone_number": "708-724-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVORY WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "PRZYBYLA",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "OWNDER",
        "authorized_official_telephone_number": "708-790-1952",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivory Wellness",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ivory Wellness & Aesthetics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in River Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.