Provider Demographics
NPI:1962381202
Name:IBRAIMOVA, AIZADA (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AIZADA
Middle Name:
Last Name:IBRAIMOVA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W DEVON AVE UNIT 59111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-6081
Mailing Address - Country:US
Mailing Address - Phone:312-532-1896
Mailing Address - Fax:
Practice Address - Street 1:6717 S EVANS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-4132
Practice Address - Country:US
Practice Address - Phone:872-269-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.033043363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health