Provider Demographics
NPI:1447291752
Name:ALEXANDER, IVY M (APRN)
Entity type:Individual
Prefix:MS
First Name:IVY
Middle Name:M
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1 ROYCE CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2260
Mailing Address - Country:US
Mailing Address - Phone:860-487-9200
Mailing Address - Fax:860-487-9222
Practice Address - Street 1:1 ROYCE CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2260
Practice Address - Country:US
Practice Address - Phone:860-487-9200
Practice Address - Fax:860-487-9222
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000630363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS90776Medicare UPIN