Provider Demographics
NPI:1114514122
Name:LOW, ALEXANDRA ROSE (CNM, WHNP, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:LOW
Suffix:
Gender:F
Credentials:CNM, WHNP, IBCLC
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:866-681-0738
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:1100 VAN NESS AVE FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6978
Practice Address - Country:US
Practice Address - Phone:415-750-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-302511163WL0100X
CA95270872163WX0003X
CA236502367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Multi-Specialty