Provider Demographics
NPI:1053003798
Name:STOCKBURGER, ALEXANDREA (RN)
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:STOCKBURGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALEXANDREA
Other - Middle Name:
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8680 SKYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-1433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8680 SKYBROOK DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-1433
Practice Address - Country:US
Practice Address - Phone:423-596-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000246538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse