Individual
ALYSSA ANN DEARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APN, FNP-BC
Contact information
Practice address
151 W HIGH ST LOWR LEVEL, MORRIS, IL 60450-1407
(815) 705-1000
(815) 705-2709
Mailing address
725 SCHOOL ST STE A, MORRIS, IL 60450-1207
(815) 941-9124
(815) 941-4363
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209010633
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE (GROUP PTAN)
IL
01
—
209.010633
LICENSE
IL
01
—
F400099927
MEDICARE (INDIVIDUAL PTAN)
IL
Enumeration date
08/14/2013
Last updated
01/20/2022
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