Provider Demographics
NPI:1306356589
Name:WILSON, ALEXANDRA (CPNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N MAYFAIR RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1415
Mailing Address - Country:US
Mailing Address - Phone:414-249-2422
Mailing Address - Fax:414-961-0298
Practice Address - Street 1:2500 N MAYFAIR RD STE 500
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1415
Practice Address - Country:US
Practice Address - Phone:414-249-2422
Practice Address - Fax:414-961-0298
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8047-33363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics