Healthcare Provider Details

I. General information

NPI: 1457028177
Provider Name (Legal Business Name): ALEXANDRA NICOLE THUNHERST APRN-FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA NICOLE LYEWSKI APRN

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 IL-50 N #500
BOURBONNAIS IL
60914
US

IV. Provider business mailing address

2070 IL-50 N #500
BOURBONNAIS IL
60914
US

V. Phone/Fax

Practice location:
  • Phone: 779-236-4094
  • Fax:
Mailing address:
  • Phone: 779-236-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.003696
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: