Provider Demographics
NPI:1679941819
Name:TELISZCZAK, ALLISON ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:TELISZCZAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ANNE
Other - Last Name:SCHACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:10350 HALIGUS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9545
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-802-7112
Practice Address - Street 1:1095 PINGREE RD STE 108
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1726
Practice Address - Country:US
Practice Address - Phone:815-459-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277002816OtherSTATE LICENSE
IL209013024OtherSTATE LICENSE