Healthcare Provider Details

I. General information

NPI: 1821916800
Provider Name (Legal Business Name): ALEXANDRA MARIE CANTWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 VENETIA RD
MOBILE AL
36605-2818
US

IV. Provider business mailing address

2074 VENETIA RD
MOBILE AL
36605-2818
US

V. Phone/Fax

Practice location:
  • Phone: 251-404-8551
  • Fax:
Mailing address:
  • Phone: 251-404-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3178
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: