Healthcare Provider Details

I. General information

NPI: 1124535075
Provider Name (Legal Business Name): ALEXANDRA GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date: 03/24/2025
Reactivation Date: 03/28/2025

III. Provider practice location address

413 RUBY WALK DR
MORRISVILLE NC
27560-6740
US

IV. Provider business mailing address

2000 OLD CLINIC CB #7510
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-445-6985
  • Fax:
Mailing address:
  • Phone: 919-445-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: