Provider Demographics
NPI:1871599233
Name:ALVAREZ, JEANNE M (FNP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#28 ON HIGHWAY 571
Mailing Address - Street 2:
Mailing Address - City:EL RITO
Mailing Address - State:NM
Mailing Address - Zip Code:87530-0237
Mailing Address - Country:US
Mailing Address - Phone:575-581-4728
Mailing Address - Fax:575-581-0030
Practice Address - Street 1:STATE RD 571 BLDG #28
Practice Address - Street 2:
Practice Address - City:EL RITO
Practice Address - State:NM
Practice Address - Zip Code:87530-0237
Practice Address - Country:US
Practice Address - Phone:575-581-4728
Practice Address - Fax:575-581-4731
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME50008796OtherRAILROAD MEDICARE
NM4576021Medicaid
ME048305OtherANTHEM STAR NUMBER
ME048305OtherANTHEM STAR NUMBER
ME50008796OtherRAILROAD MEDICARE