Healthcare Provider Details

I. General information

NPI: 1386054583
Provider Name (Legal Business Name): ALYSHA HART NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST SUITE 8477206464550
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

1212 SANTA FE RD APT 308
ROMEOVILLE IL
60446-4211
US

V. Phone/Fax

Practice location:
  • Phone: 847-720-6464
  • Fax: 847-720-6463
Mailing address:
  • Phone: 773-575-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: