Provider Demographics
NPI:1811707326
Name:ALEXANDER, MYZA RAE CABOVERDE (RN)
Entity type:Individual
Prefix:MS
First Name:MYZA RAE
Middle Name:CABOVERDE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MYZA RAE
Other - Middle Name:CANON
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8701 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7035
Mailing Address - Country:US
Mailing Address - Phone:219-738-5510
Mailing Address - Fax:
Practice Address - Street 1:1248 35TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2533
Practice Address - Country:US
Practice Address - Phone:219-501-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28254136A207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services