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General NPI Number Information
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NPI Number | 1194102277
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Entity Type | Individual
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Provider Name | MINI ALEXANDER FNP
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Gender | Female
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 2840 W DAUPHIN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-4627
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Country | US
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Telephone | 215-685-2403
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 W DAUPHIN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-4697
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Country | US
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Telephone | 215-685-2403
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN557566
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014656
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License Number State | PA
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