Healthcare Provider Details

I. General information

NPI: 1992194401
Provider Name (Legal Business Name): ALYSSA R. LOEPKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA R MUETH

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY
HIGHLAND IL
62249-1960
US

IV. Provider business mailing address

6810 STATE ROUTE 162 BOX 215
MARYVILLE IL
62062
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0022
  • Fax: 618-651-0023
Mailing address:
  • Phone: 618-391-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-012494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: