Provider Demographics
NPI:1831439108
Name:ALEXANDER, NICOLE N (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:N
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:NABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3236 E GRAND AVE STE I
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5100
Mailing Address - Country:US
Mailing Address - Phone:073-760-8602
Mailing Address - Fax:307-288-6065
Practice Address - Street 1:3236 E GRAND AVE STE I
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5100
Practice Address - Country:US
Practice Address - Phone:307-760-8602
Practice Address - Fax:307-288-6065
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1722363A00000X
WYPA590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant