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General NPI Number Information
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NPI Number | 1821703109
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Entity Type | Individual
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Provider Name | ALEXANDRIA BROOK MANSOOROV CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 201 GOVERNORS DR SUITE 400
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5183
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Country | US
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Telephone | 256-265-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 3615 SWEARENGIN RD
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City | GRANT
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State | AL
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Zip | 35747-7763
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Country | US
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Telephone | 256-572-3280
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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 | 1-149900
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License Number State | AL
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