Healthcare Provider Details

I. General information

NPI: 1447973300
Provider Name (Legal Business Name): ALEXA SCANLAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 E SPRING VALLEY RD STE G
MAYER AZ
86333-4263
US

IV. Provider business mailing address

17301 E SPRING VALLEY RD STE G
MAYER AZ
86333-4263
US

V. Phone/Fax

Practice location:
  • Phone: 928-404-8004
  • Fax: 623-374-5576
Mailing address:
  • Phone: 928-404-8004
  • Fax: 623-374-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: