Provider Demographics
NPI:1679925895
Name:SELL, ALEXIS ROSE (MSN, RN, NP-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ROSE
Last Name:SELL
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Mailing Address - Street 2:1 NORMAL AVENUE
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1624
Mailing Address - Country:US
Mailing Address - Phone:973-655-4361
Mailing Address - Fax:
Practice Address - Street 1:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Practice Address - Street 2:1 NORMAL AVENUE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307715363LA2200X
NJ26NJ00628400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health