MEDICARE: MRS. ALYSSA C TOREN CNM

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
1	176B00000X	Midwife	MO4454	IL

General Provider Information

NPI Number	:	1902310030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSSA C TOREN CNM

Provider Business Mailing Address
First Line	:	1130 N MILWAUKEE AVE APT 2R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-4017
Country	:	US
Telephone Number	:	262-903-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3162
Country	:	US
Telephone Number	:	312-670-2530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	11/28/2017

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