Provider Demographics
NPI:1992182331
Name:WEBB, ALYSON (NP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E LAKE SHORE DR
Mailing Address - Street 2:STE 310
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3803
Mailing Address - Country:US
Mailing Address - Phone:217-464-1220
Mailing Address - Fax:217-464-1229
Practice Address - Street 1:1750 E LAKE SHORE DR
Practice Address - Street 2:STE 310
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3803
Practice Address - Country:US
Practice Address - Phone:217-464-1220
Practice Address - Fax:217-464-1229
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily