ALYSSA ANN DEARTH MSN APN FNP-BC NPI 1376976365

NPI Information

NPI: 1376976365
Provider Name: ALYSSA ANN DEARTH, MSN, APN, FNP-BC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
151 W HIGH ST LOWR LEVEL
MORRIS, IL
ZIP 60450
Phone: (815) 705-1000
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Alyssa Ann Dearth, MSN, APN, FNP-BC is a family nurse practitioner in Morris, IL. Alyssa Ann Dearth, MSN, APN, FNP-BC NPI is 1376976365. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

151 W HIGH ST LOWR LEVEL
MORRIS, IL
ZIP 60450-407
Phone: (815) 705-1000
Fax: (815) 705-2709

The NPI 1376976365 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 8/14/2013 and was last updated on 1/20/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	209010633	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	206147	OTHER	ILLINOIS	MEDICARE (GROUP PTAN)
2	209.010633	OTHER	ILLINOIS	LICENSE
3	F400099927	OTHER	ILLINOIS	MEDICARE (INDIVIDUAL PTAN)

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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