Healthcare Provider Details

I. General information

NPI: 1720809098
Provider Name (Legal Business Name): ALEXANDRA RAY KOWNURKO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 KENNETT PIKE STE 100
WILMINGTON DE
19807-3019
US

IV. Provider business mailing address

3506 KENNETT PIKE STE 100
WILMINGTON DE
19807-3019
US

V. Phone/Fax

Practice location:
  • Phone: 302-661-3375
  • Fax: 302-661-3374
Mailing address:
  • Phone: 302-661-3375
  • Fax: 302-661-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN699033
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010829
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0010246
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0053475
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: