Provider Demographics
NPI:1295105484
Name:BURCHARDT, ALISON ELAINE (APN)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ELAINE
Last Name:BURCHARDT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2025 S CHICAGO ST
Mailing Address - Street 2:STE 1
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-3173
Mailing Address - Country:US
Mailing Address - Phone:815-726-2200
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BOULEVARD
Practice Address - Street 2:PAVILION A, SUITE 240
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-740-1900
Practice Address - Fax:815-485-4458
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209013337363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology