Provider Demographics
NPI:1659900389
Name:BEATTIE, ALEXANDRA MARIA (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:MARIA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 E RAILROAD AVE # D102
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-1015
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-625-2075
Practice Address - Street 1:700 W IRONWOOD DR STE 155
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4462
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-625-2075
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3771963363LP0200X
CANP95020961363L00000X
CARN95166137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse