Provider Demographics
NPI:1689092132
Name:VERHEYEN, ALYSSA RYANNE GODDARD (FNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RYANNE GODDARD
Last Name:VERHEYEN
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:2133 VADALABENE DR
Mailing Address - Street 2:SUITE # 5B
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5839
Mailing Address - Country:US
Mailing Address - Phone:618-288-7605
Mailing Address - Fax:618-288-7644
Practice Address - Street 1:6812 STATE ROUTE 162
Practice Address - Street 2:SUITE 202
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8553
Practice Address - Country:US
Practice Address - Phone:618-288-7605
Practice Address - Fax:618-288-7644
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2015-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209011377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily