Healthcare Provider Details

I. General information

NPI: 1013764059
Provider Name (Legal Business Name): ALEXANDRA CHRISTINA NIELSON-JOSEPH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 NEWARK GRANVILLE RD
GRANVILLE OH
43023-1436
US

IV. Provider business mailing address

594 NEWARK GRANVILLE RD
GRANVILLE OH
43023-1436
US

V. Phone/Fax

Practice location:
  • Phone: 740-618-2322
  • Fax: 740-618-2324
Mailing address:
  • Phone: 740-618-2322
  • Fax: 740-618-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0036216
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: