Provider Demographics
NPI:1235778655
Name:GLOVER, ALEXANDRA REGINA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:REGINA
Last Name:GLOVER
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 1:2104 WATT ABBITT RD
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-5566
Mailing Address - Country:US
Mailing Address - Phone:434-660-2110
Mailing Address - Fax:
Practice Address - Street 1:2104 WATT ABBITT RD
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-5566
Practice Address - Country:US
Practice Address - Phone:434-660-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide