Healthcare Provider Details

I. General information

NPI: 1962989020
Provider Name (Legal Business Name): ALEXANDRA WOZNIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 CEDAR LN STE 103
COLUMBIA MD
21044-3898
US

IV. Provider business mailing address

6334 CEDAR LN STE 103
COLUMBIA MD
21044-3898
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-2355
  • Fax: 410-531-7041
Mailing address:
  • Phone: 410-340-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR188842
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR188842
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: