Healthcare Provider Details

I. General information

NPI: 1386139079
Provider Name (Legal Business Name): ALEXYS LEANNE AMUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21579 N 84TH LN
PEORIA AZ
85382-4447
US

IV. Provider business mailing address

21579 N 84TH LN
PEORIA AZ
85382-4447
US

V. Phone/Fax

Practice location:
  • Phone: 602-750-7954
  • Fax:
Mailing address:
  • Phone: 602-750-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-144089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: