Healthcare Provider Details

I. General information

NPI: 1184123267
Provider Name (Legal Business Name): ALEXIS LAUREN REIGER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS LAUREN KOCH WHNP

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MONTGOMERY ST STE 200
SAN FRANCISCO CA
94111-1019
US

IV. Provider business mailing address

1725 MONTGOMERY ST STE 200
SAN FRANCISCO CA
94111-1019
US

V. Phone/Fax

Practice location:
  • Phone: 415-666-1250
  • Fax: 415-398-2696
Mailing address:
  • Phone: 415-666-1250
  • Fax: 415-398-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95008518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: