Provider Demographics
NPI:1861414914
Name:ALONSO, LARRY (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 GREEN RIVER PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3966
Mailing Address - Country:US
Mailing Address - Phone:505-977-2967
Mailing Address - Fax:
Practice Address - Street 1:ACOMA-ACOMA-LAGUNA HOSPITAL
Practice Address - Street 2:EXIT 102 OFF HWY I-40
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-831-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily