Provider Demographics
NPI:1154066850
Name:NORMAN, ALYSSA (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 N 3709TH RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9473
Mailing Address - Country:US
Mailing Address - Phone:815-830-0331
Mailing Address - Fax:
Practice Address - Street 1:2012 N 3709TH RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9473
Practice Address - Country:US
Practice Address - Phone:815-830-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041478438163WC0200X, 367500000X
IL209025350367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine