Provider Demographics
NPI:1538443585
Name:ALONSO, KATHERINE R (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:R
Last Name:ALONSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:RAMBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:700 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4396
Mailing Address - Country:US
Mailing Address - Phone:978-689-2400
Mailing Address - Fax:978-683-0663
Practice Address - Street 1:700 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4396
Practice Address - Country:US
Practice Address - Phone:978-689-2400
Practice Address - Fax:978-683-0663
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2264828363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110091483AMedicaid