Provider Demographics
NPI:1578048757
Name:PENZIAS, ALEXANDRA (DNP, APRN, ACNS-BC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:PENZIAS
Suffix:
Gender:F
Credentials:DNP, APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1012
Mailing Address - Country:US
Mailing Address - Phone:857-939-9024
Mailing Address - Fax:
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:857-939-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242773364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA242773OtherMA BOARD OF REGISTRATION IN NURSING