Provider Demographics
NPI:1669680179
Name:ALONSO, LAURIE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAIN STREET
Mailing Address - Street 2:VISITING NURSE SERVICE & HOSPICE OF SUFFOLK
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 MAIN STREET
Practice Address - Street 2:VISITING NURSE SERVICE & HOSPICE OF SUFFOLK
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1954
Practice Address - Country:US
Practice Address - Phone:631-930-9321
Practice Address - Fax:631-912-1121
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340588363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology