Provider Demographics
NPI:1700407210
Name:RABBAN, ALEXANDRA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:RABBAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39851 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3716
Mailing Address - Country:US
Mailing Address - Phone:248-345-8336
Mailing Address - Fax:
Practice Address - Street 1:6149 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7128
Practice Address - Country:US
Practice Address - Phone:734-728-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily