Provider Demographics
NPI:1760835177
Name:ALONZO, NADINE (LAC)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:ALONZO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:MARIE-LOUISE
Other - Last Name:ALONZO-BRILLANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:4315 NORWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2531
Mailing Address - Country:US
Mailing Address - Phone:910-920-6869
Mailing Address - Fax:
Practice Address - Street 1:4315 NORWICK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2531
Practice Address - Country:US
Practice Address - Phone:910-920-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist