Provider Demographics
NPI:1457390973
Name:FERNANDEZ, ALEXANDER (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0215
Mailing Address - Country:US
Mailing Address - Phone:304-952-1000
Mailing Address - Fax:
Practice Address - Street 1:141 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9700
Practice Address - Country:US
Practice Address - Phone:276-988-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001076374367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457390973Medicaid
KY7100002430Medicaid
VA012064W82Medicare PIN
KY7100002430Medicaid