Healthcare Provider Details

I. General information

NPI: 1366365918
Provider Name (Legal Business Name): CARRIE JALEE ALYASIRI MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR STE 210
BLOOMINGTON IL
61701-7906
US

IV. Provider business mailing address

1505 EASTLAND DR STE 210
BLOOMINGTON IL
61701-7906
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-5090
  • Fax:
Mailing address:
  • Phone: 309-661-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: