Healthcare Provider Details

I. General information

NPI: 1104600345
Provider Name (Legal Business Name): ALEXANDRA SCHOOLCRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE STE 201
CHARLESTON WV
25304-1063
US

IV. Provider business mailing address

5607 CAMPBELLS CREEK DR
CHARLESTON WV
25306-9110
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-2047
  • Fax:
Mailing address:
  • Phone: 304-807-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number38296
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: