Provider Demographics
NPI:1114235637
Name:LAMOTHE, ALEXANDRA M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:M
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 AUGUST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1933
Mailing Address - Country:US
Mailing Address - Phone:631-804-7836
Mailing Address - Fax:
Practice Address - Street 1:801 GAZZOLA DR
Practice Address - Street 2:
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4900
Practice Address - Country:US
Practice Address - Phone:631-447-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336182-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily