Healthcare Provider Details

I. General information

NPI: 1326569781
Provider Name (Legal Business Name): ALEXANDRA RUANE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA SOPHER FNP, PMHNP

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 NEWMAN SPRINGS RD BLDG 1-4TH
RED BANK NJ
07701-5688
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 1-4TH
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 732-934-6463
  • Fax:
Mailing address:
  • Phone: 732-934-6463
  • Fax: 732-913-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00767800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00767800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024710
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13737028-4405
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number77381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: