Provider Demographics
NPI:1962269548
Name:ALEXANDER, MIA DARYA (FNP-C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:DARYA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 HANES MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1309
Mailing Address - Country:US
Mailing Address - Phone:203-980-4717
Mailing Address - Fax:
Practice Address - Street 1:1094 HANES MALL BLVD STE 1140
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1309
Practice Address - Country:US
Practice Address - Phone:743-212-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine