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General NPI Number Information
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NPI Number | 1023779378
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Entity Type | Individual
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Provider Name | ALEXANDRA MAYBERRY
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 3655 VISTA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2539
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Country | US
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Telephone | 314-577-6056
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Fax |
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Provider Business Mailing Address
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Address Line | 233 N 1ST ST
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City | BREESE
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State | IL
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Zip | 62230-1617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2021018971
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License Number State | MO
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