Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | L8-0000209 | DE |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NJCATEMP-032239 | NJ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP021567 | PA |
NPI | 1023580644 |
---|---|
Provider Name | Summer C Alonso |
First Address | Chadds Ford, PA 19317-9307 |
Second Address | Conshohocken, PA 19428-1784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 28/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285266643 | GROUP NPI-ALPHA COUNSELING SERVICES (01) | |
815011376 | TAX ID- ALPHA COUNSELING SERVICES (01) | NJ |