Healthcare Provider Details

I. General information

NPI: 1508137217
Provider Name (Legal Business Name): LISA M ALEXIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 02/24/2021
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W BENSON BLVD STE 315
ANCHORAGE AK
99503-3677
US

IV. Provider business mailing address

1400 W BENSON BLVD STE 315
ANCHORAGE AK
99503-3677
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4009
  • Fax: 907-929-4902
Mailing address:
  • Phone: 907-929-4009
  • Fax: 907-929-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2224
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1076
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: