Healthcare Provider Details

I. General information

NPI: 1679247993
Provider Name (Legal Business Name): ALYSSA GORDON DNP, FNP-BC, CNL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 KENMORE AVE
DEERFIELD IL
60015-4745
US

IV. Provider business mailing address

PO BOX 1073
DEERFIELD IL
60015-6001
US

V. Phone/Fax

Practice location:
  • Phone: 847-650-7235
  • Fax:
Mailing address:
  • Phone: 847-650-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019777
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: