MEDICARE: MRS. ALEXANDRA OTT 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	363LA2200X	Adult Health Nurse Practitioner	SP014882	PA
2	363LG0600X	Gerontology Nurse Practitioner	SP014882	PA

General Provider Information

NPI Number	:	1851771125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA OTT CRNP

Provider Business Mailing Address
First Line	:	901 LANCASTER AVE
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-1710
Country	:	US
Telephone Number	:	484-995-2622
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 LANCASTER AVE
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-1710
Country	:	US
Telephone Number	:	484-995-2622
Fax Number	:

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

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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