=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194562793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSIA A MORET-SCHMERBACH APRN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2024
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 HEALTH SERVICES DR
-----------------------------------------------------
City | DEKALB
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60115-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-756-5255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 RANDALL RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-307-7799
-----------------------------------------------------
Fax | 630-307-2277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209.030003
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------