Healthcare Provider Details

I. General information

NPI: 1083775183
Provider Name (Legal Business Name): CORAZON P ALVARADO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 JORDAN RD SW
FORT PAYNE AL
35968-3691
US

IV. Provider business mailing address

2202 JORDAN RD SW
FORT PAYNE AL
08701-3324
US

V. Phone/Fax

Practice location:
  • Phone: 256-844-2825
  • Fax: 256-844-1804
Mailing address:
  • Phone: 256-844-2825
  • Fax: 256-844-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN05817300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-143265
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: