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General NPI Number Information
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NPI Number | 1780446278
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Entity Type | Individual
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Provider Name | ALYSSA ELLIS PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 1701 E WOODFIELD RD STE 401
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5126
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Country | US
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Telephone | 224-650-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 BAILEY RD
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City | SYCAMORE
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State | IL
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Zip | 60178-3057
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Country | US
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Telephone | 815-762-1699
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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 | 209029497
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License Number State | IL
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