Provider Demographics
NPI:1750416061
Name:ALEXANDER, SHONA R (NP-C)
Entity type:Individual
Prefix:
First Name:SHONA
Middle Name:R
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 OAK TREE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2569
Mailing Address - Country:US
Mailing Address - Phone:800-897-9177
Mailing Address - Fax:
Practice Address - Street 1:500 SPRINGHOUSE CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6718
Practice Address - Country:US
Practice Address - Phone:770-879-4330
Practice Address - Fax:678-684-3066
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168429363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBHXZMedicare ID - Type UnspecifiedMEDICARE #
GAQ30072Medicare UPIN