Provider Demographics
NPI:1851915961
Name:ALTERSON, JENNIFER LEANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANDRA
Last Name:ALTERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3861
Mailing Address - Country:US
Mailing Address - Phone:575-415-1927
Mailing Address - Fax:575-488-1133
Practice Address - Street 1:1111 10TH ST # 469
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6413
Practice Address - Country:US
Practice Address - Phone:312-520-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner