Healthcare Provider Details

I. General information

NPI: 1376550186
Provider Name (Legal Business Name): ALEXANDRA D STEVENS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4806 NE 139TH AVE
VANCOUVER WA
98682-6353
US

IV. Provider business mailing address

4806 NE 139TH AVE
VANCOUVER WA
98682-6353
US

V. Phone/Fax

Practice location:
  • Phone: 360-551-8511
  • Fax:
Mailing address:
  • Phone: 360-551-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00015580
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA155580
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: