Provider Demographics
NPI:1235905191
Name:KIRCZOW, ALEXANDRA (RN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KIRCZOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 W CARE CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2331
Mailing Address - Country:US
Mailing Address - Phone:435-719-5547
Mailing Address - Fax:435-719-3971
Practice Address - Street 1:382 W CARE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2331
Practice Address - Country:US
Practice Address - Phone:435-719-5547
Practice Address - Fax:435-719-3971
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12624282-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse