Healthcare Provider Details

I. General information

NPI: 1194688697
Provider Name (Legal Business Name): ALISUN BETH CASHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 N CLYBOURN AVE
CHICAGO IL
60610-2003
US

IV. Provider business mailing address

1276 N CLYBOURN AVE
CHICAGO IL
60610-2003
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.034078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: