Provider Demographics
NPI:1396192829
Name:KNUEVEN, ALYSSA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NICOLE
Last Name:KNUEVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4073
Mailing Address - Country:US
Mailing Address - Phone:708-653-8993
Mailing Address - Fax:
Practice Address - Street 1:3749 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2019
Practice Address - Country:US
Practice Address - Phone:708-422-6569
Practice Address - Fax:708-499-1511
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical