=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023264496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONJA MELISSA ALEXANDER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2008
-----------------------------------------------------
Last Update Date | 01/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 SAINT PAUL PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-332-9205
-----------------------------------------------------
Fax | 410-545-4611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7864B MAYFAIR CIR
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21043-6972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-880-5597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R153098
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------