Healthcare Provider Details

I. General information

NPI: 1699664789
Provider Name (Legal Business Name): ANTEA VANESSA ALEXANDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTEA VANESSA DEGRAFFENREID

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

72 MAIN ST
SUTTON MA
01590-1608
US

V. Phone/Fax

Practice location:
  • Phone: 774-441-8081
  • Fax:
Mailing address:
  • Phone: 774-214-6884
  • Fax: 774-214-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2321929
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: