Healthcare Provider Details

I. General information

NPI: 1871599233
Provider Name (Legal Business Name): JEANNE M ALVAREZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/23/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE RD 571 BLDG #28
EL RITO NM
87530-0237
US

IV. Provider business mailing address

#28 ON HIGHWAY 571
EL RITO NM
87530-0237
US

V. Phone/Fax

Practice location:
  • Phone: 575-581-4728
  • Fax: 575-581-4731
Mailing address:
  • Phone: 575-581-4728
  • Fax: 575-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: