Provider Demographics
NPI:1013211572
Name:ALFONSI, LUZ ELENA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:ELENA
Last Name:ALFONSI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:ELENA
Other - Last Name:DEGISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:205 ELM ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2342
Practice Address - Country:US
Practice Address - Phone:636-390-4071
Practice Address - Fax:636-390-8908
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019678363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000006069Medicare PIN