Provider Demographics
NPI:1295172153
Name:ALEXANDER, PAMELA LEA (LPN)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LEA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 UPPER FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2106
Mailing Address - Country:US
Mailing Address - Phone:585-298-5831
Mailing Address - Fax:
Practice Address - Street 1:41 O,CONNOR ROAD
Practice Address - Street 2:MONROE #1 BOCES
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-377-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272020-13140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric