Provider Demographics
NPI:1396308458
Name:PAPE, ALEXANDRA H (CNM)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:H
Last Name:PAPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 191ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8802
Mailing Address - Country:US
Mailing Address - Phone:708-572-7669
Mailing Address - Fax:
Practice Address - Street 1:10260 191ST ST STE 100
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8802
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-422-4358
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041404155363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology