Healthcare Provider Details

I. General information

NPI: 1003401936
Provider Name (Legal Business Name): ALEXANDRA MARIE HOLMES APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2662 N LINCOLN AVE
CHICAGO IL
60614-1307
US

IV. Provider business mailing address

2662 N LINCOLN AVE
CHICAGO IL
60614-1307
US

V. Phone/Fax

Practice location:
  • Phone: 773-657-5111
  • Fax: 773-295-1182
Mailing address:
  • Phone: 773-657-5111
  • Fax: 773-295-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.034872
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028290
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016081
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: