MEDICARE: MAIRE ALEXANDER ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	0024167937	VA

General Provider Information

NPI Number	:	1093967630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIRE ALEXANDER ANP-BC

Provider Business Mailing Address
First Line	:	7939 LAKE PLEASANT DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7939 LAKE PLEASANT DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2750
Country	:	US
Telephone Number	:	703-455-0117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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