| Doctor Name: | ALYSHA HART |
| NPI Number: | 1386054583 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 209011353 |
| Business Practice Address: | 2400 Caton Farm Rd Suite K Crest Hill, IL - 604031386 |
| Business Phone Number: | 8156099081 |
| Business Fax Number: | |
| Mailing Address: | 1212 Santa Fe Rd, Apt 308 ROMEOVILLE |
| State: | IL |
| Postal Code: | 604464211 |
| Phone Number: | 7735757587 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2014 |
| NPI Last Update Date: | 04/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209011353 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |