Healthcare Provider Details

I. General information

NPI: 1760909154
Provider Name (Legal Business Name): LINDA FREW ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD STE 620
SHAKER HTS OH
44122-5340
US

IV. Provider business mailing address

20600 CHAGRIN BLVD STE 620
SHAKER HEIGHTS OH
44122-5340
US

V. Phone/Fax

Practice location:
  • Phone: 216-751-4762
  • Fax: 216-751-5894
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number160318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: