Healthcare Provider Details

I. General information

NPI: 1962779686
Provider Name (Legal Business Name): ALEXA J GORDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXA J MCINNIS APRN

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 FARMINGTON RD
ROCHESTER NH
03867-4352
US

IV. Provider business mailing address

178 FARMINGTON RD
ROCHESTER NH
03867-4352
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-1133
  • Fax:
Mailing address:
  • Phone: 603-332-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN277741
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number056355-21
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number056355-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: