Healthcare Provider Details

I. General information

NPI: 1134603996
Provider Name (Legal Business Name): ALEXANDRIA P ROSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ENDO LN STE 1
HAMLET NC
28345-4567
US

IV. Provider business mailing address

108 ENDO LN STE 1
HAMLET NC
28345-4567
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number258012
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: