Provider Demographics
NPI:1881712529
Name:MAY, ALISA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LYNN
Last Name:MAY
Suffix:
Gender:F
Credentials:LPN
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 111
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:IL
Mailing Address - Zip Code:61467-0111
Mailing Address - Country:US
Mailing Address - Phone:309-483-6266
Mailing Address - Fax:
Practice Address - Street 1:2323 WINDISH DR
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-9780
Practice Address - Country:US
Practice Address - Phone:309-344-4200
Practice Address - Fax:309-344-4281
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-102526164W00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175OtherFEIN BWAY ORG
IL043-102526OtherDPR