MEDICARE: MS. IVY M. ALEXANDER APRN

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	363LP2300X	Primary Care Nurse Practitioner	000630	CT

General Provider Information

NPI Number	:	1447291752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVY M. ALEXANDER APRN

Provider Business Mailing Address
First Line	:	1 ROYCE CIR
Second Line	:	SUITE 104
City	:	STORRS
State	:	CT
Zip	:	06268-2260
Country	:	US
Telephone Number	:	860-487-9200
Fax Number	:	860-487-9222

Provider Business Practice Location Address
First Line	:	1 ROYCE CIR
Second Line	:	SUITE 104
City	:	STORRS
State	:	CT
Zip	:	06268-2260
Country	:	US
Telephone Number	:	860-487-9200
Fax Number	:	860-487-9222

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/02/2015

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