Provider Demographics
NPI:1053854323
Name:LAYTON, ALICIA
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:LAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FRANKLIN AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3558
Mailing Address - Country:US
Mailing Address - Phone:309-268-5130
Mailing Address - Fax:309-268-5784
Practice Address - Street 1:1304 FRANKLIN AVE STE 380
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3558
Practice Address - Country:US
Practice Address - Phone:309-268-5130
Practice Address - Fax:309-268-5784
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015017363L00000X
IL209015017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner