Healthcare Provider Details

I. General information

NPI: 1831329598
Provider Name (Legal Business Name): ALEXIS LYNN GURECKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 INDEPENDENCE PKWY STE 120
CHESAPEAKE VA
23320-5114
US

IV. Provider business mailing address

PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0798
  • Fax: 757-547-0145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: