Provider Demographics
NPI:1821356494
Name:ALEXANDER, KATHERINE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
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 1:30 BROAD ST
Mailing Address - Street 2:45TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2304
Mailing Address - Country:US
Mailing Address - Phone:212-530-0630
Mailing Address - Fax:212-867-4353
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:45TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-530-0630
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY336181OtherLICENSE
NY331943Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY336181OtherLICENSE
NY331946Medicare Oscar/Certification