Healthcare Provider Details

I. General information

NPI: 1174309652
Provider Name (Legal Business Name): ALEXIS SENU DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

112 BUFFALO TRCE
STOCKBRIDGE GA
30281-2914
US

V. Phone/Fax

Practice location:
  • Phone: 710-793-5000
  • Fax:
Mailing address:
  • Phone: 203-702-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN320268
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: