Healthcare Provider Details

I. General information

NPI: 1205440310
Provider Name (Legal Business Name): ALEXA KUCHARO A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 12/06/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

5100 N MILLER RD UNIT 47
SCOTTSDALE AZ
85250-7741
US

V. Phone/Fax

Practice location:
  • Phone: 623-256-3660
  • Fax:
Mailing address:
  • Phone: 623-256-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number241663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: