Healthcare Provider Details

I. General information

NPI: 1629910849
Provider Name (Legal Business Name): ALLISON NUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON HEAVILIN

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N SANGAMON AVE
GIBSON CITY IL
60936-1345
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 217-784-8148
  • Fax:
Mailing address:
  • Phone: 217-784-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: