Healthcare Provider Details

I. General information

NPI: 1255291266
Provider Name (Legal Business Name): GAGE LEE ALEXANDER BSN, DNAP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2549
US

IV. Provider business mailing address

11100 S RIVER HEIGHTS DR APT D104
SOUTH JORDAN UT
84095-6228
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-6000
  • Fax:
Mailing address:
  • Phone: 385-695-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number13820908-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95428100
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: