Provider Demographics
NPI:1386054583
Name:HART, ALYSHA (NP-C)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1212 SANTA FE RD
Mailing Address - Street 2:APT 308
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4211
Mailing Address - Country:US
Mailing Address - Phone:773-575-7587
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 8477206464550
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-720-6464
Practice Address - Fax:847-720-6463
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209011353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily