Provider Demographics
NPI:1710535240
Name:MCCONVILLE, ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BUCKSTOWN RD STE E206
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1815
Mailing Address - Country:US
Mailing Address - Phone:215-741-1963
Mailing Address - Fax:215-741-1914
Practice Address - Street 1:100 N BUCKSTOWN RD STE E206
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1815
Practice Address - Country:US
Practice Address - Phone:152-741-1963
Practice Address - Fax:215-741-1914
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN512044L163W00000X
PASP021218363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner