Healthcare Provider Details

I. General information

NPI: 1992174072
Provider Name (Legal Business Name): ALEXA RHEA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 JUNIPER DR STE 2
LEWISTON ID
83501-4719
US

IV. Provider business mailing address

PO BOX 341
LEWISTON ID
83501-0341
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-9001
  • Fax: 208-848-9002
Mailing address:
  • Phone: 208-743-8416
  • Fax: 208-743-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCS50718
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: