Provider Demographics
NPI:1912383167
Name:POTTER, ALEXANDRA CHRISTINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:POTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KEMP AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7278
Mailing Address - Country:US
Mailing Address - Phone:518-229-5589
Mailing Address - Fax:
Practice Address - Street 1:15 KEMP AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7278
Practice Address - Country:US
Practice Address - Phone:518-229-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686205163WH0200X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care