Provider Demographics
NPI:1245395557
Name:ALEXANDER, MARY MORRIS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MORRIS
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMIT CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2216
Mailing Address - Country:US
Mailing Address - Phone:704-671-6300
Mailing Address - Fax:704-671-6307
Practice Address - Street 1:705 SUMMIT CROSSING PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2216
Practice Address - Country:US
Practice Address - Phone:704-671-6300
Practice Address - Fax:704-671-6307
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300354363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics