Provider Demographics
NPI:1164844312
Name:MATT, ALLISON N (RN, BSN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:N
Last Name:MATT
Suffix:
Gender:F
Credentials:RN, BSN, MSN, NP-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:N
Other - Last Name:GLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8296
Mailing Address - Fax:847-984-5689
Practice Address - Street 1:3715 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5483
Practice Address - Country:US
Practice Address - Phone:815-759-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019647363LF0000X
IL041.387154163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)