Healthcare Provider Details

I. General information

NPI: 1306565643
Provider Name (Legal Business Name): ALEXA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-0640
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: