Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5003498 | NC |
NPI | 1295030955 |
---|---|
Provider Name | Alexandra Marie Lavenburg |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2011 |
Last Update Date | 05/03/2021 |