Healthcare Provider Details

I. General information

NPI: 1285475921
Provider Name (Legal Business Name): ALEXANDRA FAYE MATSIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 JEFFERSON ST
SANFORD NC
27330-5636
US

IV. Provider business mailing address

128 JENNISON RD
MILFORD NH
03055-4260
US

V. Phone/Fax

Practice location:
  • Phone: 919-842-5190
  • Fax:
Mailing address:
  • Phone: 603-801-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2353364
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5020794
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020794
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: