MEDICARE: MRS. ALEXANDRA W KROEFF PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-15912	NC
2	363A00000X	Physician Assistant	0110011314	VA

General Provider Information

NPI Number	:	1194964635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA W KROEFF PA

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	3825 CONLON WAY #100
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909
Country	:	US
Telephone Number	:	252-331-5869
Fax Number	:	252-331-5906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/02/2026

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