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General NPI Number Information
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NPI Number | 1750195087
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Entity Type | Individual
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Provider Name | ALYSSA LYNNE HOGAN APN
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 7037 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60649-1905
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Country | US
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Telephone | 312-355-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 8831 S CONSTANCE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-2955
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209031420
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License Number State | IL
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