Healthcare Provider Details

I. General information

NPI: 1194551663
Provider Name (Legal Business Name): MICHELLE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 DEL REY AVE APT 126
LAS VEGAS NV
89146-9245
US

IV. Provider business mailing address

6701 DEL REY AVE APT 126
LAS VEGAS NV
89146-9245
US

V. Phone/Fax

Practice location:
  • Phone: 360-296-6954
  • Fax:
Mailing address:
  • Phone: 360-296-6954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: