Healthcare Provider Details

I. General information

NPI: 1871298851
Provider Name (Legal Business Name): ALISON M KECK APRN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-3160
  • Fax:
Mailing address:
  • Phone: 630-933-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209011817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: