Basic Information
| Provider Information | |||||||||
| NPI: | 1932258993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | FISCHELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FISCHELL | ||||||||
| OtherFirstName: | ALEXANDRA | ||||||||
| OtherMiddleName: | JILL | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 S 10TH ST | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | LILLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275466690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108934111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4140 FERNCREEK DR | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104842171 | ||||||||
| FaxNumber: | 9104844568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0010-00296 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | P00282727 | 01 | NC | RAILROAD MEDICARE | OTHER |