Active NPI
Alexandra M Wack, CRNP
- Nurse Practitioner
- Bryn Mawr, PA
National Provider Identifier
1770866402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- SP011592
- Practice address
- 918 County Line Rd
Bryn Mawr, PA 19010-2502 - Phone
- (610) 525-6086
- Fax
- (610) 525-6631
- NPI assigned
- Sep 20, 2011
- Last updated
- Sep 20, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | SP011592 | PA | Primary |
Addresses
Primary practice location
918 County Line Rd
Bryn Mawr, PA 19010-2502
Mailing address
918 County Line Rd
Bryn Mawr, PA 19010-2502
Phone (610) 525-6086
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP011592 | PA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316476800000",
"number": "1770866402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "918 COUNTY LINE RD",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190102502",
"telephone_number": "610-525-6086",
"fax_number": "610-525-6631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "918 COUNTY LINE RD",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190102502",
"telephone_number": "610-525-6086",
"fax_number": "610-525-6631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACK",
"first_name": "ALEXANDRA",
"middle_name": "M",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-20",
"last_updated": "2011-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "SP011592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryn Mawr, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.