Provider Demographics
NPI:1922038132
Name:NESBIT, ALEXANDRIA E (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:E
Last Name:NESBIT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:E
Other - Last Name:CHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:900 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1900
Mailing Address - Country:US
Mailing Address - Phone:207-907-3010
Mailing Address - Fax:207-907-3011
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-907-3010
Practice Address - Fax:207-907-3011
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEW84317Medicare UPIN
MEAP2511Medicare PIN