Provider Demographics
NPI:1871464388
Name:DURZO, ALYSSA KHRISTINE (PNP)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:KHRISTINE
Last Name:DURZO
Suffix:
Gender:F
Credentials:PNP
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 7412125
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2125
Mailing Address - Country:US
Mailing Address - Phone:314-862-4050
Mailing Address - Fax:314-862-1141
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2326
Practice Address - Country:US
Practice Address - Phone:314-862-4050
Practice Address - Fax:314-862-1141
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025039807363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty