Healthcare Provider Details

I. General information

NPI: 1003612342
Provider Name (Legal Business Name): ALEXA BUIKEMA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 CHICORY RIDGE WAY
ROSCOE IL
61073-6367
US

IV. Provider business mailing address

11022 CHICORY RIDGE WAY
ROSCOE IL
61073-6367
US

V. Phone/Fax

Practice location:
  • Phone: 815-670-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041411769
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: