Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2008019678 | MO |
NPI | 1013211572 |
---|---|
Provider Name | Mrs. Luz Elena Alfonsi |
First Address | Saint Louis, MO 63128-3854 |
Second Address | Washington, MO 63090-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 07/04/2011 |