Provider Demographics
NPI:1649810987
Name:WESLEY, ALISHA M (MSN, CNM, APRN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
Last Name:WESLEY
Suffix:
Gender:F
Credentials:MSN, CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 BETHANY RD STE C
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3160
Mailing Address - Country:US
Mailing Address - Phone:815-899-8080
Mailing Address - Fax:815-899-8002
Practice Address - Street 1:1675 BETHANY RD STE C
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3160
Practice Address - Country:US
Practice Address - Phone:815-899-8080
Practice Address - Fax:815-899-8002
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020680367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife