Provider Demographics
NPI:1669751780
Name:PRICE, ALEXANDRA ANDREA (CNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANDREA
Last Name:PRICE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ANDREA
Other - Last Name:MENDONCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1920
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:617-568-4780
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1920
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4780
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2265168363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400127557Medicare PIN