Provider Demographics
NPI:1851880371
Name:LORENTSEN, ALEXANDRA GILLESPY
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GILLESPY
Last Name:LORENTSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEDIATRIC EDUCATION OFFICE CB 7593
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7593
Mailing Address - Country:US
Mailing Address - Phone:919-966-3172
Mailing Address - Fax:919-966-8419
Practice Address - Street 1:PEDIATRIC EDUCATION OFFICE 230 MACNIDER HALL
Practice Address - Street 2:333 SOUTH COLUMBIA STREET
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-966-3172
Practice Address - Fax:919-966-8419
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238457390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program