Healthcare Provider Details

I. General information

NPI: 1134658883
Provider Name (Legal Business Name): ALEXANDRA DEBOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0724
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: