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NPI Code Detail

MEDICARE: ALEXANDRA WISENALL

MEDICARE: ALEXANDRA WISENALL
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
1363L00000XNurse Practitioner103828WV

General Provider Information

NPI Number : 1427600725
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA WISENALL
Provider Business Mailing Address
First Line : 302 ROCK CLIFF DR
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-2838
Country : US
Telephone Number : 304-944-4432
Fax Number : 304-944-4417
Provider Business Practice Location Address
First Line : 302 ROCK CLIFF DR
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-2838
Country : US
Telephone Number : 304-944-4432
Fax Number : 304-944-4417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2019
Last Update Date : 05/28/2026

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Directions to “ ALEXANDRA WISENALL ” Practice Location

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