Provider Demographics
NPI:1780156281
Name:ANGEL, ALYSA (APRN, FNP-BC, PMHNP)
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:
Last Name:ANGEL
Suffix:
Gender:
Credentials:APRN, FNP-BC, PMHNP
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 27
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1087
Mailing Address - Country:US
Mailing Address - Phone:407-797-8726
Mailing Address - Fax:
Practice Address - Street 1:151 E BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3000
Practice Address - Country:US
Practice Address - Phone:630-783-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028277171000000X, 363LW0102X, 363LF0000X
FL9296432363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171000000XOther Service ProvidersMilitary Health Care Provider
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health