Provider Demographics
NPI:1285266973
Name:HAMER, ALEXANDRA JANE (LMBT)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:JANE
Last Name:HAMER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 ARNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3104
Mailing Address - Country:US
Mailing Address - Phone:919-682-8102
Mailing Address - Fax:
Practice Address - Street 1:715 ARNETTE AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3104
Practice Address - Country:US
Practice Address - Phone:919-682-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00083OtherNC BOARD OF MASSAGE AND BODYWORK THERAPY