Healthcare Provider Details

I. General information

NPI: 1710301296
Provider Name (Legal Business Name): ALEXANDRA DANAE RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA ROBISON MD

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 PROFESSIONAL WAY
SHELTON WA
98584
US

IV. Provider business mailing address

733 RUTLAND AV THE JOHNS HOPKINS SCHOOL OF MEDICINE
BALTIMORE MD
21205-2109
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-3102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60954444
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: