Provider Demographics
NPI:1417136664
Name:ALEXANDER, NANCY L (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:795 E SECOND ST.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-469-8332
Mailing Address - Fax:909-706-3785
Practice Address - Street 1:8686 HAVEN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9110
Practice Address - Country:US
Practice Address - Phone:909-706-3950
Practice Address - Fax:909-257-2300
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2016-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF507ZOtherSO CA PTAN
CAS84194Medicare UPIN
CADF507ZOtherSO CA PTAN