1396921433 NPI number — MRS. ALEXANDRA ANDERSON COLVIN M.S.

Table of content: MRS. ALEXANDRA ANDERSON COLVIN M.S. (NPI 1396921433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396921433 NPI number — MRS. ALEXANDRA ANDERSON COLVIN M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLVIN
Provider First Name:
ALEXANDRA
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
ALEXANDRA
Provider Other Middle Name:
SKINNER
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396921433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 NIGHTINGALE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-5668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-517-0095
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4490 HOLLAND OFFICE PARK
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-639-2218
Provider Business Practice Location Address Fax Number:
866-594-3899
Provider Enumeration Date:
01/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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