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General NPI Number Information
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NPI Number | 1710165881
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Entity Type | Individual
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Provider Name | JESSICA LYNN ALCON-ROMERO CNP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 1010 SPRUCE ST PMG ESPANOLA
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City | ESPANOLA
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State | NM
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Zip | 87532-2724
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Country | US
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Telephone | 505-367-0365
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Fax | 505-367-0362
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICES
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R62161
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02437
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License Number State | NM
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