Healthcare Provider Details

I. General information

NPI: 1447169909
Provider Name (Legal Business Name): ALLYSEN WEINER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLYSEN MARTINEZ RN

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SEMINARY AVE
AURORA IL
60505-4768
US

IV. Provider business mailing address

838 SHAGBARK LN APT 103
NORTH AURORA IL
60542-1416
US

V. Phone/Fax

Practice location:
  • Phone: 638-299-5550
  • Fax:
Mailing address:
  • Phone: 630-299-5550
  • Fax: 630-299-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1283333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: