Healthcare Provider Details

I. General information

NPI: 1659132413
Provider Name (Legal Business Name): ALENA WROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W HILL BLVD
CHARLESTON AFB SC
29404-4704
US

IV. Provider business mailing address

307 BOATNER RD
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: