Provider Demographics
NPI:1245851344
Name:ANSELMO, ALEXA SALVADOR (NP)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:SALVADOR
Last Name:ANSELMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:SALVADOR
Other - Last Name:SEQUEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:111 DARROW ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3631
Mailing Address - Country:US
Mailing Address - Phone:413-335-0766
Mailing Address - Fax:
Practice Address - Street 1:41 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1446
Practice Address - Country:US
Practice Address - Phone:781-756-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313065163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency