Provider Demographics
NPI:1164105490
Name:STRUBLE, ALISSA LEIGH (FNP)
Entity type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:LEIGH
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-9160
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:DEPT EMERGENCY MEDICINE
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8012
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-747-9160
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024035390363L00000X
IL0041488224163W00000X
MO2019000479163W00000X
IL209030058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily