Provider Demographics
NPI:1003591736
Name:ST LAURENT, ALEXA LEE
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:LEE
Last Name:ST LAURENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 WEST ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3552
Mailing Address - Country:US
Mailing Address - Phone:410-224-7667
Mailing Address - Fax:410-224-7007
Practice Address - Street 1:2024 WEST ST STE 400
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3552
Practice Address - Country:US
Practice Address - Phone:410-224-7667
Practice Address - Fax:410-224-7007
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR246940363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily