Provider Demographics
NPI:1831763796
Name:ALVARADO, VANESSA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ALVARADO
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 1:5907 94TH ST # E8
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5049
Mailing Address - Country:US
Mailing Address - Phone:718-699-0500
Mailing Address - Fax:
Practice Address - Street 1:5907 94TH ST # E8
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5049
Practice Address - Country:US
Practice Address - Phone:718-699-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347330-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily