Healthcare Provider Details

I. General information

NPI: 1649113036
Provider Name (Legal Business Name): ALEXANDER WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 N GAVIN LOOP
COEUR D ALENE ID
83815-0050
US

IV. Provider business mailing address

6709 N GAVIN LOOP
COEUR D ALENE ID
83815-0050
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-1887
  • Fax: 208-556-7824
Mailing address:
  • Phone: 208-755-1887
  • Fax: 208-556-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELYN DEE ALEXANDER
Title or Position: OWNER/CEO/PRACTITIONER
Credential: DNP, FNP-C
Phone: 208-755-1887