Provider Demographics
NPI:1225152838
Name:DUQUE, ALELI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ALELI
Middle Name:
Last Name:DUQUE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-7678
Mailing Address - Country:US
Mailing Address - Phone:956-519-0528
Mailing Address - Fax:
Practice Address - Street 1:427 E DURANTA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3409
Practice Address - Country:US
Practice Address - Phone:956-787-0770
Practice Address - Fax:956-787-0995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558605363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165-0293Medicaid
TX088-3035Medicaid
TX088-3035Medicaid