Basic Information
| Provider Information | |||||||||
| NPI: | 1528544335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER ROBERTSON | ||||||||
| FirstName: | QUISHA | ||||||||
| MiddleName: | SHERANE | ||||||||
| NamePrefix: | |||||||||
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| OtherLastName: | ALEXANDER | ||||||||
| OtherFirstName: | QUISHA | ||||||||
| OtherMiddleName: | SHERANE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6120B WOODLAND AVE | ||||||||
| Address2: | FL 2 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191423224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164285362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4700 WISSAHICKON AVE BLDG D | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158439720 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2018 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP018915 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.