Healthcare Provider Details

I. General information

NPI: 1184426629
Provider Name (Legal Business Name): ALYSSA NICOLE NASTYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 OAKRIDGE DR APT 10
AURORA IL
60502-4512
US

IV. Provider business mailing address

2272 OAKRIDGE DR APT 10
AURORA IL
60502-4512
US

V. Phone/Fax

Practice location:
  • Phone: 773-343-6135
  • Fax:
Mailing address:
  • Phone: 773-343-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: