Healthcare Provider Details

I. General information

NPI: 1831706597
Provider Name (Legal Business Name): MARTHA LUZ ALEJANDRO-BIRD AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KINGS WAY STE &3300
WILLIAMSBURG VA
23185-2505
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-0750
  • Fax: 757-229-5168
Mailing address:
  • Phone: 757-316-5800
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024179412
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: