Provider Demographics
NPI:1598482481
Name:FORD, ALEXANDRIA (LPN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 EDDY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9329
Mailing Address - Country:US
Mailing Address - Phone:315-573-0530
Mailing Address - Fax:
Practice Address - Street 1:4648 EDDY RIDGE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9329
Practice Address - Country:US
Practice Address - Phone:315-573-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse