Provider Demographics
NPI:1467015396
Name:ALEXANDER, LAURA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANE
Other - Last Name:WACHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4301
Mailing Address - Country:US
Mailing Address - Phone:510-643-5808
Mailing Address - Fax:510-643-5079
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-6621
Practice Address - Fax:510-642-1801
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA321961OtherCALIFORNIA BOARD OF REGISTERED NURSING