Provider Demographics
NPI:1659841963
Name:KOERTEN, ALEXANDRA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KOERTEN
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6320
Mailing Address - Country:US
Mailing Address - Phone:781-281-9505
Mailing Address - Fax:
Practice Address - Street 1:5 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-6320
Practice Address - Country:US
Practice Address - Phone:781-281-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2320583163WM0102X
MACLC283630163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn