Healthcare Provider Details

I. General information

NPI: 1427989102
Provider Name (Legal Business Name): ALEXANDRA A EWING IBCLC, DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 N 11TH ST APT 8
PHOENIX AZ
85014-4828
US

IV. Provider business mailing address

4002 N 11TH ST APT 8
PHOENIX AZ
85014-4828
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-8748
  • Fax:
Mailing address:
  • Phone: 480-766-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86060128
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-306214
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: