Healthcare Provider Details

I. General information

NPI: 1821615485
Provider Name (Legal Business Name): DENISE M ALEXANDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N LINTEL DRIVE
BLOOMINGTON IN
47404-8975
US

IV. Provider business mailing address

21 EASTBROOK BEND, STE 218
PEACHTREE CITY GA
30269-1546
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-2815
  • Fax:
Mailing address:
  • Phone: 678-967-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: