Provider Demographics
NPI:1578747135
Name:ALEXANDER, MARY ROSE (RN, LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ROSE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5731
Mailing Address - Country:US
Mailing Address - Phone:501-663-2850
Mailing Address - Fax:
Practice Address - Street 1:109 S MARTIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5731
Practice Address - Country:US
Practice Address - Phone:501-663-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR7877176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife