Provider Demographics
NPI:1396477675
Name:MYERS, ALEXANDRA RAE (RN)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:RAE
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ALEXANDRA
Other - Middle Name:RAE
Other - Last Name:STREU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 MARBLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2058
Mailing Address - Country:US
Mailing Address - Phone:505-272-4475
Mailing Address - Fax:505-272-8088
Practice Address - Street 1:2600 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2058
Practice Address - Country:US
Practice Address - Phone:505-272-4475
Practice Address - Fax:505-272-8088
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM63729163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult