Healthcare Provider Details

I. General information

NPI: 1336539980
Provider Name (Legal Business Name): ALLISON KELSEY MOSER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

1665 VIRGINIA DR
ELK GROVE VILLAGE IL
60007-2961
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4837
  • Fax:
Mailing address:
  • Phone: 847-347-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041371175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: