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NPI Code Detail

MEDICARE: ALYSSA GOERGEN

MEDICARE: ALYSSA GOERGEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209.023500IL

General Provider Information

NPI Number : 1457026320
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA GOERGEN
Provider Business Mailing Address
First Line : 900 RAND RD STE 300
Second Line :
City : DES PLAINES
State : IL
Zip : 60016-2359
Country : US
Telephone Number : 847-324-3976
Fax Number : 847-929-1154
Provider Business Practice Location Address
First Line : 4700 GILBERT AVE STE 51
Second Line :
City : WESTERN SPRINGS
State : IL
Zip : 60558-1664
Country : US
Telephone Number : 708-387-1737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2021
Last Update Date : 01/25/2022

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Directions to “ ALYSSA GOERGEN ” Practice Location

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