=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588916555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE ALEXANDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2012
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 TORRENCE AVE
-----------------------------------------------------
City | CALUMET CITY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60409-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-323-8622
-----------------------------------------------------
Fax | 224-225-0388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 TORRENCE AVE
-----------------------------------------------------
City | CALUMET CITY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60409-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-323-8622
-----------------------------------------------------
Fax | 224-225-0388
-----------------------------------------------------
=====================================================
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 | 277-000781
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 277-000781
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------