Provider Demographics
NPI:1639186901
Name:ALEXANDER, STEPHANIE L (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:B
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 10TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8795
Practice Address - Country:US
Practice Address - Phone:218-246-8275
Practice Address - Fax:218-246-8279
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024127876363L00000X
MN204077-0363LA2200X
MNCNP498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204077-0OtherSTATE LICENSE
VAC06778OtherGROUP PTAN
VA10001438OtherSENTARA
VAC06778OtherGROUP PTAN
VA10001438OtherSENTARA
VAMA0791752OtherDEA