Provider Demographics
NPI:1235955436
Name:ALCAMO, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:ALCAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:AGOSTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2940 LAKE TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7800
Mailing Address - Country:US
Mailing Address - Phone:305-416-4045
Mailing Address - Fax:
Practice Address - Street 1:2940 LAKE TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7800
Practice Address - Country:US
Practice Address - Phone:305-416-4045
Practice Address - Fax:530-541-4624
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439173163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics