Provider Demographics
NPI:1326195702
Name:ALEXANDER, SUSAN (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 7TH ST SE # 3
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3378
Mailing Address - Country:US
Mailing Address - Phone:256-350-6182
Mailing Address - Fax:256-350-6184
Practice Address - Street 1:4421 W PLEASANT ACRES DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5729
Practice Address - Country:US
Practice Address - Phone:256-350-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066697363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531443OtherBCBS OF AL PROVIDER NUMBE
AL051554429Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ALQ02374Medicare UPIN