Healthcare Provider Details

I. General information

NPI: 1093967630
Provider Name (Legal Business Name): MAIRE ALEXANDER ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 LAKE PLEASANT DR
SPRINGFIELD VA
22153-2750
US

IV. Provider business mailing address

7939 LAKE PLEASANT DR
SPRINGFIELD VA
22153-2750
US

V. Phone/Fax

Practice location:
  • Phone: 703-455-0117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167937
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: