Provider Demographics
NPI:1780936344
Name:ALEXANDER, STEFANI (APN)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3316
Mailing Address - Country:US
Mailing Address - Phone:219-398-9685
Mailing Address - Fax:219-398-9695
Practice Address - Street 1:1313 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3316
Practice Address - Country:US
Practice Address - Phone:219-398-9685
Practice Address - Fax:219-398-9695
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.369779163W00000X
IN28247136A163W00000X
IN710008458A363L00000X
IL209.009790363LW0102X
IN710008458363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021372Medicaid