Healthcare Provider Details

I. General information

NPI: 1205178928
Provider Name (Legal Business Name): SARA JAYNE ALEXANDER ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

111 GUMDROP PATH
APEX NC
27502-1853
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4026
  • Fax:
Mailing address:
  • Phone: 636-667-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2004017918
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013007650
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5006929
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: