Individual
LYNESSA A ALONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
10 SAINT CLARE CT, WASHINGTON, IL 61571-9239
(309) 886-4003
Mailing address
10 SAINT CLARE CT, WASHINGTON, IL 61571-9239
(309) 886-4003
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036-111658
IL
208000000X
Pediatrics Physician
Primary
036111658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000597576
NCMA/ANTHEM
—
01
—
000023044Z
NCMA/HUM
—
05
—
036111658
—
IL
01
—
101430
NCMA/SIHO
—
05
—
7100079490
—
KY
01
—
P00736603
RAILROAD MEDICARE
—
Enumeration date
09/29/2006
Last updated
02/24/2012
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