Healthcare Provider Details

I. General information

NPI: 1891317194
Provider Name (Legal Business Name): ALEXANDRA EDMONSON RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 STATE ST
MERIDEN CT
06450-3293
US

IV. Provider business mailing address

134 STATE ST
MERIDEN CT
06450-3293
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2229
  • Fax:
Mailing address:
  • Phone: 203-237-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9047
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number153488
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: