Healthcare Provider Details

I. General information

NPI: 1801490586
Provider Name (Legal Business Name): ALEXIS PORTERFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
YOUNGSTOWN OH
44555-0001
US

IV. Provider business mailing address

385 MATHEWS RD
YOUNGSTOWN OH
44512-3046
US

V. Phone/Fax

Practice location:
  • Phone: 330-941-3650
  • Fax:
Mailing address:
  • Phone: 301-885-9568
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: