Provider Demographics
NPI:1982332227
Name:ALFONSO, MARIA JILL BUENA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIA JILL
Middle Name:BUENA
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 OCEAN PORT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0210
Mailing Address - Country:US
Mailing Address - Phone:702-612-8711
Mailing Address - Fax:
Practice Address - Street 1:1330 KAREN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1260
Practice Address - Country:US
Practice Address - Phone:702-625-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN56862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily