Provider Demographics
NPI:1952520876
Name:ALEXANDER, MARYELLEN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-3727
Mailing Address - Country:US
Mailing Address - Phone:347-729-5368
Mailing Address - Fax:
Practice Address - Street 1:203 EAST BROWN STREET
Practice Address - Street 2:POCONO MEDICAL CENTER
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-421-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335128-1363LF0000X
DELP0000358363LF0000X
PASP009544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily