MEDICARE: ANGEL ALEXANDER

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	164W00000X	Licensed Practical Nurse	148314	OH

General Provider Information

NPI Number	:	1780856682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL ALEXANDER

Provider Business Mailing Address
First Line	:	38506 OAK HILL LN
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-7657
Country	:	US
Telephone Number	:	440-391-4452
Fax Number	:

Provider Business Practice Location Address
First Line	:	38506 OAK HILL LN
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-7657
Country	:	US
Telephone Number	:	440-391-4452
Fax Number	:

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	06/03/2013

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