Provider Demographics
NPI:1780003533
Name:CANTOR, ALEXANDRA C (CRNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:C
Last Name:CANTOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4373
Mailing Address - Country:US
Mailing Address - Phone:717-988-8020
Mailing Address - Fax:717-221-5567
Practice Address - Street 1:302 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-812-2390
Practice Address - Fax:717-812-2388
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102926830Medicaid