Provider Demographics
NPI:1740973437
Name:BOUSAMRA-WRIGHT, ALEXANDRIA (APRN)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:BOUSAMRA-WRIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:BOUSAMRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7110 WESTHAVEN CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7745
Mailing Address - Country:US
Mailing Address - Phone:317-349-8120
Mailing Address - Fax:
Practice Address - Street 1:2002 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1903
Practice Address - Country:US
Practice Address - Phone:317-872-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014048A363L00000X
IN28236074A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner