Healthcare Provider Details

I. General information

NPI: 1588575963
Provider Name (Legal Business Name): ALLISON WAZORICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 E BELVIDERE RD STE 212
GRAYSLAKE IL
60030-2034
US

IV. Provider business mailing address

1013 GRANT PL
WAUCONDA IL
60084-1313
US

V. Phone/Fax

Practice location:
  • Phone: 847-543-6814
  • Fax: 847-543-0787
Mailing address:
  • Phone: 847-543-6814
  • Fax: 847-543-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: