Basic Information
| Provider Information | |||||||||
| NPI: | 1811245681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYENI | ||||||||
| FirstName: | GINETTE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 CLAIRE CT | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600257635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475561707 | ||||||||
| FaxNumber: | 8475561715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 CLAIRE CT | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600257635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474677423 | ||||||||
| FaxNumber: | 8475561715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.009645 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1811245681 | 05 | IL | MEDICAID |