Provider Demographics
NPI:1639668551
Name:ALEXANDER, EBONY A (FNP)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:A
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1732
Mailing Address - Country:US
Mailing Address - Phone:413-358-1195
Mailing Address - Fax:
Practice Address - Street 1:631B NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-2051
Practice Address - Fax:413-445-9178
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily