Healthcare Provider Details

I. General information

NPI: 1396330288
Provider Name (Legal Business Name): ALEXIS AHLBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVE SE STE 300
CEDAR RAPIDS IA
52401-2106
US

IV. Provider business mailing address

1017 BOWLER ST
HIAWATHA IA
52233-1919
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-4542
  • Fax:
Mailing address:
  • Phone: 515-346-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number105900
License Number StateIA

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: