MEDICARE: DR. ALEXANDRIA HORNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457976680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRIA HORNER

Provider Business Mailing Address
First Line	:	809 E KINGSLEY ST APT 12
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-1275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 STERLING OAKS BLVD SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9283
Country	:	US
Telephone Number	:	616-874-6696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2020
Last Update Date	:	06/24/2021

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