Provider Demographics
NPI:1720287485
Name:ALEX, ANILTTA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANILTTA
Middle Name:
Last Name:ALEX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0878
Mailing Address - Country:US
Mailing Address - Phone:630-217-6779
Mailing Address - Fax:
Practice Address - Street 1:5801 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2300
Practice Address - Country:US
Practice Address - Phone:630-217-6779
Practice Address - Fax:630-969-7166
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006397363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health