Healthcare Provider Details

I. General information

NPI: 1992618953
Provider Name (Legal Business Name): ALEXIS CANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25215 W PARK AVE
BUCKEYE AZ
85326-2569
US

IV. Provider business mailing address

25215 W PARK AVE
BUCKEYE AZ
85326-2569
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-1042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP248567
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: