Provider Demographics
NPI:1831865211
Name:IRWIN, ALEXANDRA NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTSMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41174-9105
Mailing Address - Country:US
Mailing Address - Phone:740-727-8233
Mailing Address - Fax:
Practice Address - Street 1:717 5TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4007
Practice Address - Country:US
Practice Address - Phone:740-354-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily