Provider Demographics
NPI:1992194401
Name:LOEPKER, ALYSSA R (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:LOEPKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:MUETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 VANDALIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-343-6015
Mailing Address - Fax:618-343-6028
Practice Address - Street 1:6812 STATE ROUTE 162 STE 120
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8586
Practice Address - Country:US
Practice Address - Phone:618-288-0044
Practice Address - Fax:618-288-0066
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-012494363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily