Healthcare Provider Details

I. General information

NPI: 1205740966
Provider Name (Legal Business Name): ALEXIS NICOLE DEWID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SW CENTURY DR STE 111
BEND OR
97702-1657
US

IV. Provider business mailing address

61554 OAKWOOD PL
BEND OR
97702-2001
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-6224
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: