Healthcare Provider Details

I. General information

NPI: 1316272016
Provider Name (Legal Business Name): JODY FULTON ALEXANDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 RICHARD DR
GLENSHAW PA
15116-1200
US

IV. Provider business mailing address

PO BOX 848 PO BOX 848
MARS PA
16046-0848
US

V. Phone/Fax

Practice location:
  • Phone: 724-625-3171
  • Fax:
Mailing address:
  • Phone: 724-625-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010560
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: