Provider Demographics
NPI:1235609629
Name:ALEXANDER, MARION STOLTZFUS BRADEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:STOLTZFUS BRADEN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 BEAVER POND TRL
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9050
Mailing Address - Country:US
Mailing Address - Phone:336-813-0218
Mailing Address - Fax:
Practice Address - Street 1:600 CHATHAM MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2482
Practice Address - Country:US
Practice Address - Phone:336-835-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCALEX-S4AKRJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine