Provider Demographics
NPI:1467199570
Name:GONSOR, ALEXANDRA (CLD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GONSOR
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BUCKWALTER PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5175
Mailing Address - Country:US
Mailing Address - Phone:817-793-6979
Mailing Address - Fax:
Practice Address - Street 1:337 BUCKWALTER PLACE BLVD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5175
Practice Address - Country:US
Practice Address - Phone:817-793-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula