Healthcare Provider Details

I. General information

NPI: 1407526825
Provider Name (Legal Business Name): ALEXIS RAE SCHUITEMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 06/21/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CHAPEL AVE W
CHERRY HILL NJ
08002-2048
US

IV. Provider business mailing address

3202 BLUFF VIEW CIR
BORDENTOWN NJ
08505-1179
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-6500
  • Fax:
Mailing address:
  • Phone: 908-399-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00650900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: