Healthcare Provider Details

I. General information

NPI: 1104575877
Provider Name (Legal Business Name): ALEXANDRA ELIZABETH PLONSKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4273 46TH AVE N APT 124
MINNEAPOLIS MN
55422-1346
US

IV. Provider business mailing address

4273 46TH AVE N APT 124
MINNEAPOLIS MN
55422-1346
US

V. Phone/Fax

Practice location:
  • Phone: 612-750-5475
  • Fax:
Mailing address:
  • Phone: 612-750-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2246626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: