Provider Demographics
NPI:1639569189
Name:ALONZO, ELIZABETH TERTTU (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TERTTU
Last Name:ALONZO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MOHOULI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7210
Mailing Address - Country:US
Mailing Address - Phone:808-897-5856
Mailing Address - Fax:808-935-3783
Practice Address - Street 1:200 N VINEYARD BLVD STE A325-369
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3950
Practice Address - Country:US
Practice Address - Phone:808-800-4035
Practice Address - Fax:808-800-4037
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60675856363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044829Medicaid