Provider Demographics
NPI:1053509810
Name:MULL, ALYSSA SUZANNE (CNM)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:SUZANNE
Last Name:MULL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3226
Mailing Address - Country:US
Mailing Address - Phone:586-360-3476
Mailing Address - Fax:
Practice Address - Street 1:1701 W SUPERIOR STREET
Practice Address - Street 2:ERIE FAMILY HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006659367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife