Provider Demographics
NPI:1235440983
Name:ALEXANDER, WANDA THERESA
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:THERESA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:T
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2015 SHAFTESBURY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3819
Mailing Address - Country:US
Mailing Address - Phone:937-610-5975
Mailing Address - Fax:937-610-5975
Practice Address - Street 1:2015 SHAFTESBURY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3819
Practice Address - Country:US
Practice Address - Phone:937-610-5975
Practice Address - Fax:937-610-5975
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN075986164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse