Healthcare Provider Details

I. General information

NPI: 1578506994
Provider Name (Legal Business Name): ANDREA ALICIA ALEXANDER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 SUNSET BLVD STE A
LEXINGTON SC
29072-9393
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-567-8900
  • Fax: 803-567-8909
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: