Provider Demographics
NPI:1669134045
Name:CANAVAN, ALEXA (APRN-C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:CANAVAN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:EDMUNDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 LIMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-5325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4047
Practice Address - Country:US
Practice Address - Phone:204-481-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10095363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health