Healthcare Provider Details

I. General information

NPI: 1477988293
Provider Name (Legal Business Name): ASHLEY RA-NEA ALVAREZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WASHINGTON ST
COLDWATER KS
67029-9758
US

IV. Provider business mailing address

301 S WASHINGTON ST
COLDWATER KS
67029-9758
US

V. Phone/Fax

Practice location:
  • Phone: 620-582-2136
  • Fax:
Mailing address:
  • Phone: 620-582-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76106-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: