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General NPI Number Information
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NPI Number | 1780156281
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Entity Type | Individual
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Provider Name | ALYSA ANGEL APRN, FNP-BC, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 151 E BRIARCLIFF RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3000
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Country | US
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Telephone | 630-783-2832
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1087
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Country | US
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Telephone | 910-676-2227
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028277
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 209028277
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209028277
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 377004192
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 9296432
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9296432
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License Number State | FL
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