Doctor Name: | JODY FULTON ALEXANDER |
NPI Number: | 1316272016 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | SP010560 |
Business Practice Address: | 136 Richard Dr Glenshaw, PA - 151161200 |
Business Phone Number: | 7246253171 |
Business Fax Number: | |
Mailing Address: | Po Box 848, Po Box 848 MARS |
State: | PA |
Postal Code: | 160460848 |
Phone Number: | 7246253171 |
Fax Number: | |
NPI Enumeration Date: | 10/14/2009 |
NPI Last Update Date: | 11/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP010560 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |