Healthcare Provider Details

I. General information

NPI: 1790379741
Provider Name (Legal Business Name): ALEXIS DAWN MACPHERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3363
US

V. Phone/Fax

Practice location:
  • Phone: 433-424-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001300430
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: