Healthcare Provider Details

I. General information

NPI: 1235525098
Provider Name (Legal Business Name): ALLYSON FIELDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON NICHOLAS PA-C

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N RANDALL RD STE 400
ELGIN IL
60123-7805
US

IV. Provider business mailing address

1600 N RANDALL RD STE 400
ELGIN IL
60123-7805
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-8899
  • Fax:
Mailing address:
  • Phone: 847-381-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005882
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: