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General NPI Number Information
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NPI Number | 1508605197
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Entity Type | Individual
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Provider Name | ALEXA WURM PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1201 RICKER RD
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City | SALEM
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State | IL
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Zip | 62881-4263
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Country | US
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Telephone | 618-975-4621
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Fax |
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Provider Business Mailing Address
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Address Line | 19708 US HIGHWAY 50
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City | CARLYLE
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State | IL
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Zip | 62231-2328
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Country | US
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Telephone | 618-975-4621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.031183
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041508434
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License Number State | IL
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