Provider Demographics
NPI:1508471541
Name:ANDRASKI, ALEXANDRA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ANDRASKI
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 1:3500 POWELTON AVE APT A107
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2400
Mailing Address - Country:US
Mailing Address - Phone:608-312-9078
Mailing Address - Fax:
Practice Address - Street 1:2109 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1711
Practice Address - Country:US
Practice Address - Phone:732-486-7373
Practice Address - Fax:732-782-7200
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022487363LA2200X
PARN693565163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology