Healthcare Provider Details

I. General information

NPI: 1699518175
Provider Name (Legal Business Name): ALYSON NASH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 W JACKSON ST
MORTON IL
61550
US

IV. Provider business mailing address

405 LAKESIDE AVE APT C
PEKIN IL
61554-1683
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: