Provider Demographics
NPI:1962037051
Name:ALEXANDER, REBECCA SUE (CNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 HALLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-4019
Mailing Address - Country:US
Mailing Address - Phone:513-368-7030
Mailing Address - Fax:
Practice Address - Street 1:4612 HALLANDALE DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-4019
Practice Address - Country:US
Practice Address - Phone:513-368-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF02200643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine