Healthcare Provider Details

I. General information

NPI: 1235180621
Provider Name (Legal Business Name): LAURIE T ALEXANDER C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MAIN ST
EAST AURORA NY
14052-1637
US

IV. Provider business mailing address

268 MAIN ST
EAST AURORA NY
14052-1637
US

V. Phone/Fax

Practice location:
  • Phone: 716-652-8606
  • Fax: 716-652-4448
Mailing address:
  • Phone: 716-652-8606
  • Fax: 716-652-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF420412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: