Healthcare Provider Details

I. General information

NPI: 1740113224
Provider Name (Legal Business Name): ALEXANDRA ANNE KULICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

1077 EMERALD ST APT B
SAN DIEGO CA
92109-2821
US

V. Phone/Fax

Practice location:
  • Phone: 734-545-3348
  • Fax:
Mailing address:
  • Phone: 734-545-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: