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General NPI Number Information
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NPI Number | 1629590872
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Entity Type | Individual
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Provider Name | ALEXANDRA STAUM REIF CPNP
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Gender | Female
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 1825 WOODWINDS DR
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City | WOODBURY
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State | MN
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Zip | 55125-2202
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Country | US
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Telephone | 651-323-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W PROVIDER ENROLLMENT
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City | ST PAUL
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State | MN
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Zip | 55104-3727
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5236
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License Number State | MN
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