Provider Demographics
NPI:1083296396
Name:REIS, ALICIA ANNE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:REIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 N 1403RD LN
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IL
Mailing Address - Zip Code:62338-2118
Mailing Address - Country:US
Mailing Address - Phone:217-430-9753
Mailing Address - Fax:
Practice Address - Street 1:927 BROADWAY ST STE 300
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2728
Practice Address - Country:US
Practice Address - Phone:217-223-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily