MEDICARE: MS. ALEXANDRA WYANT CRNP

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	363LC0200X	Critical Care Medicine Nurse Practitioner	SP-006128-U	PA

General Provider Information

NPI Number	:	1275515934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXANDRA WYANT CRNP

Provider Business Mailing Address
First Line	:	217 HARRISBURG AVE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-2964
Country	:	US
Telephone Number	:	717-397-5484
Fax Number	:	717-397-8407

Provider Business Practice Location Address
First Line	:	217 HARRISBURG AVE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-2964
Country	:	US
Telephone Number	:	717-397-5484
Fax Number	:	717-397-8407

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/20/2009

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