Basic Information
| Provider Information | |||||||||
| NPI: | 1598159717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLENNON | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 E PALATINE RD | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600745551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477761400 | ||||||||
| FaxNumber: | 8477761424 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 E PALATINE RD | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600745551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477761400 | ||||||||
| FaxNumber: | 8477761424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041326165 | IL | N | Nursing Service Providers | Registered Nurse | 363L00000X | 209012246 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 209-012246 | 01 | IL | ILLINOIS ADVANCE PRACTICE NURSE LICENSE NUMBER | OTHER |