Healthcare Provider Details

I. General information

NPI: 1508636200
Provider Name (Legal Business Name): MARIBEL ALVARADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

PO BOX 637
COBDEN IL
62920-0637
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-2295
  • Fax:
Mailing address:
  • Phone: 870-340-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: