Provider Demographics
NPI:1861074643
Name:RUSSELL, ALEXANDREA CAROLINE (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:CAROLINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 S 11TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3829
Mailing Address - Country:US
Mailing Address - Phone:860-402-8805
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN-STANTON RD
Practice Address - Street 2:MAP 1, SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-454-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife