Provider Demographics
NPI:1164105490
Name:STRUBLE, ALISSA L (APRN, FNP-BC, DNP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:L
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:APRN, FNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 IL STATE RTE ATTN: NURSING DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62026-0001
Mailing Address - Country:US
Mailing Address - Phone:618-650-2228
Mailing Address - Fax:
Practice Address - Street 1:2001 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-1803
Practice Address - Country:US
Practice Address - Phone:618-271-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024035390363L00000X
IL0041488224163W00000X
MO2019000479163W00000X
IL209030058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily