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General NPI Number Information
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NPI Number | 1992194401
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Entity Type | Individual
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Provider Name | ALYSSA R. LOEPKER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1212 BROADWAY
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City | HIGHLAND
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State | IL
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Zip | 62249-1960
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Country | US
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Telephone | 618-651-0022
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Fax | 618-651-0023
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Provider Business Mailing Address
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Address Line | 6810 STATE ROUTE 162 BOX 215
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City | MARYVILLE
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State | IL
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Zip | 62062
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Country | US
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Telephone | 618-391-6495
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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 | 209-012494
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License Number State | IL
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