Healthcare Provider Details

I. General information

NPI: 1376321513
Provider Name (Legal Business Name): STANISLAV ALEKSEEV RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 S CARLISLE ST
PHILADELPHIA PA
19145-4419
US

IV. Provider business mailing address

2347 S CARLISLE ST
PHILADELPHIA PA
19145-4419
US

V. Phone/Fax

Practice location:
  • Phone: 215-920-1908
  • Fax:
Mailing address:
  • Phone: 215-920-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN721198
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: