Healthcare Provider Details

I. General information

NPI: 1083397418
Provider Name (Legal Business Name): ALISON JEAN DRERUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 N BELL SCHOOL RD
ROCKFORD IL
61114-6624
US

IV. Provider business mailing address

4429 SOUTHVIEW WAY DR
SAINT LOUIS MO
63129-6718
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-0300
  • Fax: 815-639-9433
Mailing address:
  • Phone: 815-988-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041529173
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number2018020114
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-030605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: