Provider Demographics
NPI:1629590872
Name:REIF, ALEXANDRA STAUM (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:STAUM
Last Name:REIF
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:ANNE
Other - Last Name:STAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2202
Practice Address - Country:US
Practice Address - Phone:651-323-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5236363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5236OtherCNP
MN245678-8OtherMN RN LICENSE