Provider Demographics
NPI:1386184174
Name:ALEXANDER, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 W 11TH ST
Mailing Address - Street 2:APT 6G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5740
Mailing Address - Country:US
Mailing Address - Phone:646-326-9984
Mailing Address - Fax:
Practice Address - Street 1:2369 W 11TH ST
Practice Address - Street 2:APT 6G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5740
Practice Address - Country:US
Practice Address - Phone:646-326-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322486164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse