Healthcare Provider Details

I. General information

NPI: 1215876958
Provider Name (Legal Business Name): MADISON OLIVIA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 MACK RD STE 110
FAIRFIELD OH
45014-5373
US

IV. Provider business mailing address

2960 MACK RD STE 110
FAIRFIELD OH
45014-5373
US

V. Phone/Fax

Practice location:
  • Phone: 513-296-8090
  • Fax:
Mailing address:
  • Phone: 513-296-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: