Healthcare Provider Details

I. General information

NPI: 1013211572
Provider Name (Legal Business Name): LUZ ELENA ALFONSI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUZ ELENA DEGISI APRN

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ELM ST SUITE 202
WASHINGTON MO
63090-2342
US

IV. Provider business mailing address

5000 CEDAR PLAZA PKWY SUITE 350
SAINT LOUIS MO
63128-3854
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-4071
  • Fax: 636-390-8908
Mailing address:
  • Phone: 314-843-4333
  • Fax: 314-843-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2008019678
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: